I'm still learning coding for Pediatrics and need help with the following.
The doctor gave Synagis injection(s) - 100mg and 50 mg
It seems it's the same CPT code 90378 - Respiratory syncytial virus, monoclonal antibody, recombinant, for IM use 50mg each. However the NCD codes are different on the 50mg vial and 100mg vial.
Not sure how to bill this out. Our system only allows one NCD code on the CPT. 90378 x 3?
Also, would I bill 96372 for the injection twice? it looks to be two separate injections being done.
And last is Z29.11 Encounter for prophylactic immunotherapy for respiratory syncytial virus (RSV) enough Dx on the claim, or do you need another code to indicate why the child is 'high risk'?
Synagis is given for several clinical situations to high-risk infants, therefore, it must be documented and coded to prove medical necessity. A few conditions may be Prematurity, Chronic Lung Disease, Congenital Heart disease, Immunocompromised children and Cystic Fibrosis to name a few conditions.
There is only one CPT code for reporting Synagis, 90378 is used for reporting, if you look at the description this CPT code reflects each 150 mg, the dosage is dependent on the weight of the patient, therefore, if 100 mg was administered you would report X3. Just be sure you are using the correct NDC code as Synagis is packaged per does one for 50 mg and one for 100mg
In addition, be sure to report the administration codes. Such as 96372 as appropriate, do not report modifier 51, if performed with another procedure.
Regarding the NDC quantity information, submit the NDC quantity in the red shaded portion under Box 24 D. The quantity of vials is to be preceded by the appropriate unit’s qualifier: UN.
50 mg vial 60574411401
100 mg vial 60574411301.
If your software does not allow you to bill both in Box 24, you may also use Box 19 for additional information.
Remember to be sure and report the pre-authorization # as this is a very expensive drug, and usually requires pre-authorization.