Yes, you read it right, Rocephin Shot (Ceftriaxone IV Injection) coding can increase medical reimbursement revenue. Yes, it is ethically and legally possible by billing for the procedure, the supply, and the E/M service correctly.
Rocephin (ceftriaxone sodium) is a cephalosporin antibiotic administered as Intramuscular (IM) or Intravenous(IV) injection. It works by fighting bacteria in your body. Rocephin is used to treat many kinds of bacterial infections, including severe or life-threatening forms such as meningitis.
Using CPT Code 90788 for the Rocephin Injection IV will get you $16.80. Use of NDC Code J0696 for Rocephin Short (Ceftriaxone Sodium) will reimburse you $13.35.
For 1 gram of ceftriaxone sodium, bill 4 units J0696 as the increments of 250 mg as 1 unit. It means if a doctor office uses Rocephin (ceftriaxone) 1 gram the code J0696 will be used as 4 units, which is equal to 1000 mg. However, make sure that you are using the correct NDC per vial.
Learn how to document Rocephin Shot (Ceftriaxone Sodium IV Injection) properly:
J0696 Rocephin Shot IV Injection (Ceftriaxone) Coding
For maximum Rocephin shot reimbursement, please follow these steps:
- J0696 Rocephin Injection, Ceftriaxone Sodium, Per 250 mg
HCPCS code J0696 should be charged per unit. When Rocephin shot is administered at the medical practice, the medical biller should report CPT 90788 (Intramuscular injection of antibiotic [specify]). Physicians use Rocephin, a type of antibiotic, which you may know by the generic name of ceftriaxone sodium, to treat serious bacterial infections
Even if an insurer doesn’t pay much for 90788, this is the correct code to use. You may mistakenly use 90782 (Therapeutic, prophylactic or diagnostic injection [specify material injected]; subcutaneous or intramuscular) as a catchall injection code. But 90782 isn’t for an antibiotic injection. Code 90782 instead describes a therapeutic, prophylactic or diagnostic injection. Translation: Use 90782 for a preventive shot, such as Synagis for respiratory syncytial virus (RSV), or a restorative treatment, like Decadron for croup.The difference between 90782 and 90788 is the injection material.
Watch out: The only time that you should report 90788 for a Rocephin injection is if your payer instructs you to do so.
- 90788 CPT Code use for injection
Remember that 90782 includes the administration only — you still need to bill for the supply. You should report the Rocephin with J0696 (Injection, ceftriaxone sodium, per 250 mg) per 250 mg.
Make sure you charge for the dose that you administer. For each 250 mg of Rocephin, you should bill one unit of J0696. List the unit(s) in the units field of the claim form next to the supply code. If you use a partial unit, such as 600 mg, round up to the next unit.
If appeals fail, consider writing a prescription for Rocephin. If you have a nearby pharmacy, the parent can pick up the antibiotic and return to your office for the injection. But sending the parent out to pick up the Rocephin for a very sick child may not be convenient, timely or appropriate.
- 99201-99215 E/M Code for office visit
For the evaluation, history and medical decision-making that lead you to administer the injection, you should report an office visit (99201-99215, Office or other outpatient visits for the evaluation and management of a new or established patient …). After examining and assessing the child, the physician decides that an antibiotic injection is the best treatment.
Often, the visit may qualify for a high-level E/M, such as 99214 or 99215. Before Rocephin injections were available, these patients would usually require intravenous antibiotics in the hospital. Now, the pediatrician can give a shot in the office. But the level of risk associated with these cases is still high.