Coding, Classification and Reimbursement

Coding bill Axumin A4641 dosage

  • 1.  Coding bill Axumin A4641 dosage

    Posted 06-26-2019 13:26
    When ​billing Axumin - HCPCS code A4641- radiopharmaceutical, diagnostic. Question posed to me is that if the standard dose is 10 mCi and for instance, we are only giving 8, do we code extra 2 as waste? My answer was - Since it is not being disposed of I can not see how it could be billed with JW modifier. But he wants a more concrete answer- or a better answer than I can provide him.

    So only thing I found

    Providers must bill Axumin with HCPCS code A4641- radiopharmaceutical, diagnostic, not otherwise classified.

    Providers must indicate the number of HCPCS units (assumption: 1 unit = 1 study dose of 370 MBq [10 mCi]). mCi is a quantity of a radioactive substance having one thousandth of a curie of radioactivity which is a weight-based dosage.

    One unit of coverage for Axumin is 1 study dose = 370 MBq (10mCi).

    Maureen McKowen, RHIT
    Corporate Compliance -Clinical Review Analyst

  • 2.  RE: Coding bill Axumin A4641 dosage

    Posted 6 days ago
    From what I have read on the NDC website, Axumin is packaged in a 30 mL multi-use vial; therefore the JW modifier would not apply.

    The company we receive our product from sends us individual 10 mCi vials (usually with more than 10 mCI due to decay, etc.) however, if we give less than the 10 mCi, due to decay, patient delay, etc. we can only bill for what we give, even though we are being charged for 10 mCi. For example, the company sends us 13.2 mCi, but by the time it is given to the patient is is only 8.2 mCi, we and we give that 8.2 mC to the patient, we can only bill the patients for 8 units - even though the company charged us for 10. :(

    Hope that helps!

    Erin Miller
    Medical Review Analyst