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  4. CLINIMIX E 5/15 sulfite-free (5% Amino Acid with Electrolytes in 15% Dextrose with Calcium) Injection, 2000 mL in CLARITY Dual Chamber Container
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CLINIMIX E 5/15 sulfite-free (5% Amino Acid with Electrolytes in 15% Dextrose with Calcium) Injection, 2000 mL in CLARITY Dual Chamber Container
Item Number: 2B7721
GTIN:  0303381123048
GTIN-CS:  50300338112303
CLINIMIX E 5/15 sulfite-free (5% Amino Acid with Electrolytes in 15% Dextrose with Calcium) Injection 2000 mL in CLARITY Dual Chamber Container. NDC 0338-1123-04
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Specifications

Product Characteristics

Minimum Storage Temperature 15.0 °C
Maximum Storage Temperature 25.0 °C
Volume 2000.0 ml
Latex Free Yes
Shelf Life from Manufacture 24 Months
Acetate 80 mg/L
Amino Acid Concentration 5%
Amino Acid 200 Kcal/L
Calcium 4.5 mg/L
Chloride 39 mg/L
Container Type CLARITY
Containes Preservative No
Dextrose Concentration 15%
Dextrose 510 Kcal/L
Free Water Content 1725
Magnesium 5 mg/L
Nitrogen 8.26 g/L
Osmolarity Molperl 1395
pH 6
Phosphate 15 mEq/L
Potassium 30 mg/L
Protein 50 g/L
Rx Only Yes
Sodium 35 mg/L
Specific Gravity 1.07
Storage Recommendations Store at room temperature (25°C/77°F) (may briefly store at up to 40°C/104°F). Refrigerated storage is limited to 9 days once the protective foil overwrap has been opened. Protect from freezing.
Total Calories 710 Kcal/L

Carton

Units per Case 4.0
Carton Weight 23.0 Pfund
Carton Length 20.3 Zoll
Carton Width 9.6 Zoll
Carton Height 8.5 Zoll
Carton Volume 0.96 fc

Reimbursement Information

HCPCS Code HCPCS Description
B4193 PARENTERAL NUTRITION SOLUTION, COMPOUNDED AMINO ACID AND CARBOHYDRATES WITH ELECTROLYTES, TRACE ELEMENTS, AND VITAMINS, INCLUDING PREPARATION, ANY STRENGTH, 52 TO 73 GRAMS OF PROTEIN - PREMIX
B4197 PARENTERAL NUTRITION SOLUTION, COMPOUNDED AMINO ACID AND CARBOHYDRATES WITH ELECTROLYTES, TRACE ELEMENTS AND VITAMINS, INCLUDING PREPARATION, ANY STRENGTH, 74 TO 100 GRAMS OF PROTEIN - PREMIX
B4199 PARENTERAL NUTRITION SOLUTION, COMPOUNDED AMINO ACID AND CARBOHYDRATES WITH ELECTROLYTES, TRACE ELEMENTS AND VITAMINS, INCLUDING PREPARATION, ANY STRENGTH, OVER 100 GRAMS OF PROTEIN - PREMIX
B4189 PARENTERAL NUTRITION SOLUTION, COMPOUNDED AMINO ACID AND CARBOHYDRATES WITH ELECTROLYTES, TRACE ELEMENTS, AND VITAMINS, INCLUDING PREPARATION, ANY STRENGTH, 10 TO 51 GRAMS OF PROTEIN - PREMIX
Medication Delivery Reimbursement Hotline 888-338-0001

Information Source : CMS

Disclaimer:The coverage, coding, and payment information included in this guide has been compiled from various resources for informational use as a tool to assist providers with reimbursement issues. This information is current as of 3/31/2008; however this information is subject to change and should not be construed as legal advice. Providers should exercise independent clinical judgment when selecting codes and submitting claims to accurately reflect services rendered to individual patients. Baxter Healthcare Corporation does not guarantee success in obtaining insurance payments. Providers are encouraged to contact third-party payors for specific information on their coverage, coding, and payment policies.
Ordering Information
Item Number 2B7721
Sales Unit case
GTIN 0303381123048
GTIN-CS 50300338112303
National Drug Code 00338112304
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