J2704 | HCPCS Code For Propofol | Description & Billing Guide

Propofol is a drug/injection and can be used for anesthesia purposes. The HCPCS code J2704 is often incorrectly referred to as the CPT code for Propofol, but propofol is not described by Current Procedural Terminology.

HCPCS code J2705 can be used for the propofol injection of 10 ml. The HCPCS code description of propofol explains that multiple pricing indicators can be used along with the base unit’s used value.

The base unit used for J2705 Propofol injection has a particular purpose, and its dosage should be given to the patient carefully. 

The intensity of anesthetic procedure services and the base unit, which accounts for everything except time, have a direct association.

Regular preoperative and postoperative checkups, the provision of fluids and blood as part of anesthetic treatment, and other forms of monitoring are among them.

Remember that the payment amount for anesthetic services can be calculated with base units, time units, and conversion factors.

CMS classifies propofol 10 mg injections HCPCS code J2704 as intravenous drugs. Therefore, propofol 10 mg/ml infusions could give in diluted or undiluted form.

The physician should follow some important points when using propofol in the case of HCPCS code J2704.

• Propofol infusion rates should be monitored and managed with appropriate equipment such as burettes, drop counters, syringe pumps, or volumetric infusion pumps.
• Before using, give the containers a good shake.
• If the emulsion still has two distinct layers after shaking, it should not use.
• Only use fresh, unopened single-use preparations that have not expired. After use, every piece of material must throw out.
• Wipe the rubber membrane with an alcohol spray or a wet brush before use. After usage, dispose of the container using the tap.
• Because propofol is a lipid emulsion with no antibacterial preservatives, it may stimulate the rapid growth of microorganisms. After breaking the vial seal, the emulsion must be transferred aseptically into a sterile syringe or administration set. The administration must take immediate action.

For the proper usage of HCPCS J2704, in the case of infusion duration, the infusion equipment, and propofol must be kept aseptically clean.

Additional medications or fluids injected into the Propofol infusion line must situate the Y-piece connection or three-way valve near the cannula site. It is unlawful to administer propofol using a microbiological filter. 

Any propofol infusion for HCPCS J2704 should be only operated on a single patient. In addition, the physician should be warned to destroy the remaining propofol solutions after administration.

Propofol could be an emulsion delivered through injection or infusion at 10 mg per ml concentration.

Therefore, when the HCPCS code J2704 (Injection, Propofol, 10mg) should report on an outpatient bill, the status indicator changes from SI=E to SI=N. Previously, SI=E was used. (Payment will combine with reimbursement for other services under the OPPS.)

J2704 Description

J2704 is not a CPT code for propofol but an HCPCS code. There is no such thing as a CPT code for propofol. Below you can find the official description of HCPCS code J2704.

J2704: This code can be reported for 10 mg of propofol and is officially described as: “Injection, propofol, 10 mg.”

A drug medication pharmaceutical company will admit the HCPCS code J2704. For example, propofol is a widely accessible drug used to induce anesthesia in most medical contexts. It is also quite simple to get.

Contrary to controlled or scheduled medications for HCPCS J2704, propofol can not be continuously tracked, leading to faulty inventory, invoicing errors, and undiscovered drug diversion. 

To fully account for the drug’s whereabouts, the HCPCS J2704 aimed to establish a revolutionary technique for monitoring propofol mol in a single location.

According to the CMS, this code is effective from January 01, 2015. Its pricing indicator is 51 and 0 base quantity used for anesthesia purposes. 

Some payment rates under the average sales price (ASP) methodology can be altered retroactively for some pharmaceuticals and biologicals for J2704.

These retroactive modifications should be typically performed every three months. For example, an intravenous route of administration could use for the HCPCS J2704 medical procedure.

Billing Guidelines For The HCPCS Code For Propofol

The propofol injection of 10 ml (HCPCS J2704) can be subsequently included in the payment and paid for throughout the whole injection.

The individual purchases of these products should be discontinued. It is necessary to devise a system to enable this payment to be moved to your department. 

Suppose the payment files for specific pharmaceuticals and biologics covered by the ASP methodology contain payment rates that should be fixed respectively. In that case, providers should be resubmitted claims that were affected by the revisions.

 When the injection administration is submitted independently, it should be coded with the corresponding CPT code. Don’t forget to add the HCPCS Level II code for the medication.

Send in form J3490 with a narrative containing the NDC (if available) or medicine name and dosage if no specific HCPCS code is available for the drug.

When injectable medications can be used during surgery, including the appropriate HCPCS Level II code, injecting patients is considered part of the surgical procedure and does not require a separate claim.

All listed medications like HCPCS code J2704 for propofol 10 ml are manually priced and supplied with a narrative, dosage information, and NDC.

There may be instances where the drug’s invoice cost is much greater than our allocation. In this situation, a provider may use the standard appeals process to appeal for increased reimbursement.

HCPCS J2704 and any other unlisted drug codes should only be used when there is no alternative code that more accurately depicts the medication given to the patient. Every prescription that isn’t on the list must have its price manually determined and a narrative, dosing guide, and NDC. 

The invoice cost of the medication may be significantly higher than our allotment in some situations. In this scenario, a provider can be utilized the typical appeals process to submit a request for more significant compensation.

Modifiers

The HCPCS J2704 code for Propofol is a drug that reliably and swiftly induces unconsciousness. Modifier 22, modifier QX, modifier QZ, and modifier QS can be used for billing the HCPCS J2704 code for Propofol.

Adults typically need a dose of propofol ranging from 1.5 to 2.5 mg/kg to achieve general anesthesia.

A continuous intravenous infusion (about 6-12 mg/kg/h) or occasional bolus injections of propofol can both be used to sustain anesthesia (20–50 mg).

Younger patients will require greater induction doses than older children; nevertheless, a lower dosage could recommend for children who have an ASA level of III or IV. 

Report modifier QX with HCPCS code J2704 when qualified non-physician anesthetist administered Propofol under a doctor’s medical supervision.

Report modifier QZ with HCOCS code J2704 when a CRNA works without a doctor’s prescription. 

Modifier QS can be reported for monitored anesthesia care services (like HCPCS J2704. This is a modifier that a licensed non-physician anesthetist could charge.

CPT Modifier 22, also known as Increased Procedural Services, is one of the CPT modifications that could use in conjunction with HCPCS code J2704.

Is J2704 Covered By Medicare?

The calculation for payment of services considered to be “personally done” uses base units (as specified by CMS) and time that will increment in 15-minute chunks. When calculating time units, the anesthesia administration time can be recorded. 

In the HCPCS J2704, the injection of propofol 10 mg can be used for medical purposes. J2704 code could use for propofol injection, and its status indicator expresses as N according to medicare. One millilitre contains 10 milligrammes of propofol.

Medical HCPCS code J2704 (propofol 10 mg injection) can be used for anesthesia. Drugs that can be taken by the patient, such as those in pill form or utilized for self-injection, like HCPCS code J2704, are typically not covered by Medicare Part B.

Example

A patient whose age is above 55 years has a tumor in the brain. The doctor recommends the surgery.

The propofol 10 mg injection can be used for anesthesia purposes. However, the proper dose of propofol should be given to the patient. Otherwise, it will cause many severe problems for the patient.

HCPCS J2704 can be billed in this case because a 10 mg propofol injection is administered to the patient.