Question 1

What is HCPCS code J0461?

Accepted Answer

HCPCS code J0461 is "Atropine sulfate injection". Injection, atropine sulfate, 0.01 mg

Question 2

What category is J0461 in?

Accepted Answer

J0461 belongs to HCPCS Category J (Drugs Administered Other Than Oral).

Question 3

When should I use HCPCS code J0461?

Accepted Answer

Use J0461 when billing for atropine sulfate injection. HCPCS Level II codes like this are used for items and services not covered by CPT codes, including medical supplies, equipment, drugs administered in clinical settings, and certain healthcare services.

Question 4

What ICD-10 codes are commonly used with J0461?

Accepted Answer

Common ICD-10 diagnosis codes used with J0461 include: A18.84 (Tuberculosis of heart), A36.81 (Diphtheritic cardiomyopathy), A39.53 (Meningococcal pericarditis), A40.0 (Sepsis due to streptococcus, group A). Always ensure proper medical documentation supports the medical necessity for the HCPCS code being billed.

Question 5

Is J0461 covered by Medicare?

Accepted Answer

Coverage for J0461 (Atropine sulfate injection) depends on medical necessity and specific Medicare guidelines. Check the applicable Local Coverage Determination (LCD) or National Coverage Determination (NCD) for detailed coverage criteria. Private insurers may have different coverage policies.

Question 6

What documentation is required for J0461?

Accepted Answer

Documentation for J0461 should include: the medical necessity for the item or service, supporting diagnosis codes (ICD-10), prescription or order from the treating physician, and proof that the item meets quality standards. Some items may require additional documentation like a Certificate of Medical Necessity (CMN).