HCPCS Level II discussion

Medication to be reported from HCPCS Level II:

Generally, HCPCS Level II codes are designed to describe products, medical equipment, as well

as other supplies (such as drugs and related medications) utilized during the performance of a given

procedure. For this discussion, I will zero in on the administration of the drug acyclovir to patient

in a health facility.

In order to come up with an accurate HCPCS Level II code for the administration of this drug, it

is necessary that the coder knows the following details:

1. Product, medical equipment, or service utilized in a given procedure: in this case,

we are looking at the case of a patient who has been administered with the drug acyclovir.

This information will inform the coder’s first step in the search for the accurate code for

this procedure.

2. Section of the HCPCS Level II codes under which the product, equipment, or

service falls: the administration of the drug acyclovir falls under the J-codes section of the

HCPCS Level II codes.

3. Mode of administration of the drug: the drug acyclovir is administered to the patient

through injections.

4. Quantity administered: the quantity administered in this case is 5mg of acyclovir

per dose.

Scenario illustrating the medical necessity for the administration of the drug

A patient visits a physician and complains about of an itching feeling beneath the skin that was

followed by fluid-filled, painful blisters. The blisters appear on the lips and around the mouth,
often break open, exude fluid, form a layer of crust and finally heals. The doctor evaluates the

sores and suspects the patient might be having herpes simplex. To confirm the diagnosis further,

the physician may obtain a swab from one sore and send it to the laboratory for further

examination. Once the physician has ascertained that the patient has the herpes simplex virus, the

doctor prescribes that the patient be injected with the drug acyclovir to relieve him of the

symptoms. The prescription entails a dose of 5 mg of acyclovir administered every eight hours for

a period of two weeks, after which the physician will evaluate the response of the patient to the

medication.

Accurate HCPCS Level II code to report:

After the procedure is completed, the accurate HCPCS Level II code to be reported by the service

provider will be HCPCS code J0133: injection of, acyclovir, 5 mg, administered every eight hours

for a period of two weeks.