HCPCS Code J1885: Injection, Ketorolac Tromethamine, per 15 mg

Learn about the correct use of HCPCS Code J1885 for Ketorolac Tromethamine injection, including its clinical uses, documentation requirements, and proper billing procedures.

Use Code

## **What is ketorolac tromethamine injection?** Ketorolac tromethamine is a nonsteroidal anti-inflammatory drug (NSAID) prescribed for the short-term management of moderately severe acute pain that cannot be adequately controlled with milder analgesics. The HCPCS code J1885 applies to the injection form of this medication at a dosage of 15 mg per unit. It is frequently administered by a healthcare provider following major surgery or in cases of severe pain that requires stronger intervention than oral medications or other drugs can provide. Ketorolac may be given intravenously or in intramuscular forms, and it is generally packaged in single dose vials. Administration involves careful monitoring, as potential adverse reactions can include gastrointestinal bleeding, kidney complications, or difficulty breathing in sensitive patients. Localized issues at the injection site, such as redness, swelling, or pain, are also possible. Because of these risks, its use is limited to a maximum of a few days, and detailed documentation in the medical record is required to justify its administration. Any discarded drugs from unused portions of a vial should also be properly noted for compliance and billing purposes.

## **Documentation requirements** Accurate documentation is crucial for billing J1885 and ensuring proper reimbursement. The medical record must include the following information: - The diagnosis for the pain, such as post-operative pain. - The medical necessity for an injectable form, explaining why oral medications are not appropriate. - The specific dose in milligrams and the route of administration. - The duration of treatment, as Ketorolac is a short-term solution. - The absence of any medical conditions that would contraindicate the treatment (e.g., a history of ulcerative colitis, Crohn's disease, or kidney disease).

## **Billing requirements** Proper billing for J1885 ensures reimbursement and compliance with payer guidelines, including the Medicare Claims Processing Manual. - Use code J1885 for Ketorolac Tromethamine per 15 mg. - Ensure the patient's diagnosis aligns with the medical necessity guidelines. - Record the total dose administered and bill the appropriate number of units (e.g., a 30 mg dose is billed as two units). - Document the date of service and the route of administration. - If a portion of a single use vial is discarded, the JW modifier may be used on a separate line of the claim to report the discarded amount. This requires specific documentation.

## **Other relevant codes** - J2270: Injection, morphine sulfate, per 10 mg - 96372: Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular - 96374: Therapeutic, prophylactic, or diagnostic injection; intravenous push, single or initial substance/drug