Antibiotic Suspension Billing Help

[mdrx33]

So I've seen this done a few times, but I was wondering if anyone knew the actual legal rules on billing an antibiotic suspension with multiple different units.

Essentially, we got a somewhat unusual antibiotic dose the other day that worked out to be a fit for 175 mL of suspension when no 175 mL unit was available, there were however 100 and 75 mL bottles. Ultimately the NDC for the more 100 mL bottle was billed for a volume of 175 mL and the bottles were dispensed. The pharmacist documented the two NDCs dispensed on the back on the Rx to clarify the billing in case of audit.

Is there a better/appropriate way to bill these orders? I know you are dispensing two NDCs under one which insurance company's could get you for, but you would think that would be better than having dispensed 200 mL and having the patient waste the excess.

If there is any legal backing to doing this one way or another would be appreciated...

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[MountainPharmD]

You bill for what you dispense. If the volume is for 175 mls you should choose the closest pack size that will give the required 175 mls. In this case you would choose 2 of the 100 ml bottles with instuctions for the patient to discard any remainded at the end. If you used the NDC for the 100 mL bottle and billed for a volume of 175 mls you did not get paid for what you used. I assume you are talking about amoxacillin. So it really does not matter since it is dirt cheap and you will never get audited on it. The bottomline is to bill for what you dispense.

The only way I see that you might get into trouble is if you do a ton of antibiotic suspensions and you up bill everyone of them. Meaning you pick the biggest pack size even if a smaller one is available. If you rountinly did this for something expensive like generic Omnicef you may raise an insurance companies suspisions.

 

[mdrx33]

What I've seen is dispensing a 75 mL and a 100 mL bottle, and billing under the 100 mL NDC for a quantity of 175 mL. This reduces waste and still bills for what is being dispensed, but I'm concerned about the use of two bottle sizes when billing for only one.

With amoxicillin obviously there is less risk, but I'm thinking of similar situations where a more expensive/brand product has been used.

 

[MountainPharmD]

What I've seen is dispensing a 75 mL and a 100 mL bottle, and billing under the 100 mL NDC for a quantity of 175 mL. This reduces waste and still bills for what is being dispensed, but I'm concerned about the use of two bottle sizes when billing for only one.

With amoxicillin obviously there is less risk, but I'm thinking of similar situations where a more expensive/brand product has been used.

There is nothng wrong with doing it this way. It takes more time. I have done it this way before. I end up pouring the 100ml and 75ml bottle into a 6 oz amber bottle so you are only dispensing one bottle. It is a pain in the ass to do it this way. You end up wasting alot of time and jacks up the on hand in the computer. It makes more work in the end.

 

[mdrx33]

Is there anywhere you know where any rules or regulations are noted on this billing?

 

[Old Timer]

Is there anywhere you know where any rules or regulations are noted on this billing?

The only rules and regulations that apply are those involving billing. If you bill a drug that does not have a MAC and there is a difference in price per ml between the 100ml and the 75 ml, you have a choice of over billing the insurance or taking the loss yourself. In that case I would dispense 200 ml, tell the pt to discard the excess and note on the prescription the manufacturers package size...

 

[Sparda29]

Just dispense 2-100 ml bottles and bill it for that to the insurance, and put instructions on the label/counsel the patient to discard the extra.

 

[Quiksilver]

at my old retail job, I remember there was no way that the computer system would allow to bill for 2 different NDCs anyways, so instead of taking the hit, just use the 200 ml bottle and bill for that. tell the patient to discard any remaining.

 

[litetigre]

I have doctors who wrote augmentin liquid for 14 day course. 1 bottle will be good enough for the quantity but the problem is augmentin suspension is good for 10 day only. We have to break the script into 2 bottles. Total dispensed quantity exceeds needed, but you have no choice. We bill insurance for the full 2 bottle.