Summary & Overview
HCPCS Level II J1267: Injection, doripenem 10 mg
HCPCS Level II code J1267 denotes the parenteral medication doripenem, 10 mg, used for treatment of serious bacterial infections where a broad-spectrum carbapenem is indicated. Nationally, precise coding for injectable antimicrobials matters for medication tracking, utilization management, and hospital pharmacy billing. The code aligns drug administration to a discrete line item on outpatient and inpatient claims, supporting clinical documentation and payer adjudication.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of what the code represents, typical sites of service, and the clinical context in which doripenem is administered. The publication summarizes billing considerations and what to expect in payer coverage practices, including common payer oversight for high-cost parenteral antimicrobials.
This piece outlines benchmarks and policy-relevant themes such as coding accuracy, utilization monitoring, and alignment with antimicrobial stewardship efforts. It is written for a national audience seeking clarity on billing and clinical context for J1267, with practical reference material for revenue cycle, pharmacy, and clinical stakeholders.
Data not available in the input for associated taxonomies, ICD-10 diagnoses, and related codes.
Billing Code Overview
HCPCS Level II code J1267 represents an injection of doripenem, 10 mg. This code indicates administration of the carbapenem-class antibiotic doripenem as a parenteral antimicrobial agent.
Service Type: Injection / Intravenous antimicrobial therapy
Typical Site of Service: Hospital outpatient departments, inpatient settings, emergency departments, and infusion centers
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Clinical & Coding Specifications
Clinical Context
A typical patient is an adult hospitalized with a severe Gram-negative bacterial infection (for example, complicated intra-abdominal infection or hospital-acquired/ventilator-associated pneumonia) requiring intravenous broad-spectrum carbapenem therapy. The clinician orders doripenem as an intravenous infusion based on culture results, susceptibilities, or empiric coverage when resistant organisms are suspected. Pharmacy verifies the J1267 product (doripenem 10 mg vial), compounds the appropriate dose and dilution, and prepares it in the sterile compounding area. Nursing administers the infusion via peripheral or central IV access, documents medication administration, monitors for infusion reactions and renal function, and adjusts dosing for renal impairment. Typical workflow steps: order entry by attending or infectious disease consultant, pharmacy verification and preparation, bedside administration by nursing, and documentation in the electronic medical record with indication, dose, route, lot number, and expiration.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
11 | Normal, or default professional services | When reporting the physician or provider’s usual service associated with ordering or supervising the infusion |