Kenalog-40 Injection (triamcinolone acetonide injectable suspension, USP) is a synthetic glucocorticoid corticosteroid with anti-inflammatory action.
Each mL of the sterile aqueous suspension provides 40 mg triamcinolone acetonide, with 0.66% sodium chloride for isotonicity, 0.99% (w/v) benzyl alcohol as a preservative, 0.63% carboxymethylcellulose sodium, and 0.04% polysorbate 80. Sodium hydroxide or hydrochloric acid may be present to adjust pH to 5.0 to 7.5. At the time of manufacture, the air in the container is replaced by nitrogen.
Disputed Code : J3301
Maximum Allowable - $8.678
How to bill J3301 with correct units
J3301 triamcinolone acetonide, (Kenalog-10, Kenalog-40) per 10 mg
Your bottle says Kenalog 40 =40 mg/ml
If you use 0.25 cc 10 mg/40 mg = 1 Unit
If you use 0.5 cc 20 mg/40 mg = 2 Units
If you use 0.75 cc 30 mg/40 mg = 3 Units
If you use 1.0 cc 40 mg/40 mg = 4 Units
How to calculate the NDC units?
Billing the correct number of NDC units for the corresponding HCPCS/CPT codes on your claims is essential. There are two ways to calculate NDC units:
Option 1 – Use Our Online NDC Units Calculator Tool
Contracted providers may access the online NDC Units Calculator Tool for assistance with converting HCPCS or CPT units to NDC units. This user friendly tool is available to payer contracted providers at no cost.
Option 2 – Calculate the NDC Units Manually
If you prefer to calculate the NDC units manually, there are several steps you will need to take. Here is a sample manual calculation
[Ciprofloxacin IV, NDC 00409-4765-86, 1200 MG (1 day supply)]:
The amount of the drug to be billed is 1200 MG, which is equal to 6 HCPCS/CPT units.
The NDC unit of measure for a liquid, solution or suspension is ML; therefore, the amount billed must be converted from MG to ML.
According to the NDC description for NDC 00409-4765-86, there are 200 MG of ciprofloxacin in 20 ML of solution (200 MG/20 ML).
Take the amount to be billed (1200 MG) divided by the number of MG in the NDC description (200 MG). 1200 ÷ 200 = 6
Multiply the result (6) by the number of ML in the NDC description (20 ML) to arrive at the correct number of NDC units to be billed on the claim (120). 6 x 20 ML = 120
When submitting NDCs on my claim, what other information need to include?
When submitting NDCs on professional/ancillary electronic (ANSI 837P) or paper (CMS-1500) claims, you must also include the following related information in order for your claim to be accepted and reviewed for possible benefits at the NDC level:
o The applicable HCPCS or CPT code
o Number of HCPCS/CPT units
o NDC qualifier (N4)
o NDC unit of measure (UN, ML, GR, F2)
o Number of NDC units (up to three decimal places)
Note: As a reminder, you also must include your billable charge.
Where to enter NDC data on electronic claim (ANSI 5010 837P) transactions?
Here are general guidelines for including NDC data in an electronic claim:
Product ID Qualifier
Enter N4 in this field
National Drug Code
Enter the 11-digit NDC billing format
assigned to the drug administered
National Drug Unit Count
Enter the quantity (number of NDC units)
Unit or Basis for Measurement
Enter the NDC unit of measure for the
prescription drug given (UN, ML, GR, or F2)