Potassium Chloride In Lactated Ringers And Dextrose Injection, Solution
NDC Package 0990-7111-09

View Billable Units, 11-Digit Conversion Format, and RxNorm mappings
Table of Contents
    1. Package Information
    2. NDC HCPCS Crosswalk
    3. Frequently Asked Questions

Package Information

Potassium Chloride In Lactated Ringers And Dextrose (potassium chloride, sodium chloride, calcium chloride, sodium lactate, and dextrose monohydrate) injection is this solution is indicated in patients requiring parenteral administration of potassium chloride and the replacement of extracellular losses of fluids and electrolytes with minimal carbohydrate calories. This formulation utilizes a injection, solution delivery system. Marketed by Icu Medical Inc., this product is identified by NDC 0990-7111 and is authorized under FDA application NDA019685.

Identification & Billing

NDC Package Code
0990-7111-09
Package Description
12 POUCH in 1 CASE / 1 BAG in 1 POUCH / 1000 mL in 1 BAG
Product Code
0990-7111
11-Digit Billing Format
00990711109
Billing Unit
ML - Billing unit of "milliliter" is used when a product is measured by its liquid volume.
RxNorm Crosswalk
  • RxCUI: 847626 - potassium chloride 20 MEQ/L in lactated Ringers solution with dextrose 5 % Injectable Solution
  • RxCUI: 847626 - calcium chloride 0.2 MG/ML / glucose 50 MG/ML / potassium chloride 1.79 MG/ML / sodium chloride 6 MG/ML / sodium lactate 3.1 MG/ML Injectable Solution
  • RxCUI: 847626 - calcium chloride 0.2 MG/ML / glucose 50 MG/ML / K+ chloride 1.79 MG/ML / NaCl 6 MG/ML / sodium lactate 3.1 MG/ML Injectable Solution
  • RxCUI: 847626 - calcium chloride 0.2 MG/ML / glucose 50 MG/ML / Pot chloride 1.79 MG/ML / NaCl 6 MG/ML / sodium lactate 3.1 MG/ML Injectable Solution
  • RxCUI: 847626 - calcium chloride 20 MG / potassium chloride 179 MG / sodium chloride 600 MG / sodium lactate 310 MG per 100 ML Ringer's with dextrose 5 % Injectable Solution

Clinical Specifications

Proprietary Name
Potassium Chloride In Lactated Ringers And Dextrose
Non-Proprietary Name
Potassium Chloride, Sodium Chloride, Calcium Chloride, Sodium Lactate, And Dextrose Monohydrate
Substance Name
Calcium Chloride; Dextrose Monohydrate; Potassium Chloride; Sodium Chloride; Sodium Lactate
Dosage Form
Injection, Solution - A liquid preparation containing one or more drug substances dissolved in a suitable solvent or mixture of mutually miscible solvents that is suitable for injection.
Administration Route
Intravenous - Administration within or into a vein or veins.
Active Ingredient(s)
Pharmacologic Class
Usage Information
This solution is indicated in patients requiring parenteral administration of potassium chloride and the replacement of extracellular losses of fluids and electrolytes with minimal carbohydrate calories.

Regulatory & Marketing

Labeler Name
Icu Medical Inc.
Product Type
Human Prescription Drug
FDA Application #
NDA019685
Marketing Category
NDA - A product marketed under an approved New Drug Application.
Start Marketing Date
11-25-2019
Listing Expiration
12-31-2027
Exclude Flag
N
Sample Package
No

Hierarchy Structure

Code Lineage

The NDC Directory contains ONLY information on final marketed drugs submitted to FDA electronically by labelers. A labeler might be a manufacturer, re-packager or re-labeler. The product information included in the NDC directory does not indicate that FDA has verified the information provided by the product labeler. Assigned NDC numbers are not in any way an indication of FDA approval of the product.

* Please review the full disclaimer at the bottom of this page.

Billing & HCPCS Mapping

To facilitate insurance claims and reimbursement, this drug package is mapped to specific HCPCS administrative codes. This crosswalk aligns clinical data with the billing standards used in ASP (Average Sales Price), AWP, and OPPS payment systems. Use the cards below to identify the correct billable units for provider claims.

J7121
Source: PDAC
5% DEXTROSE IN LACTATED RINGERS INFUSION, UP TO 1000 CC
HCPCS Dosage 1000 ML
Units / Pkg

Note for Medical Coders: These mappings are synthesized from various CMS datasets including OPPS, PrEP, and DAC (Data Analysis and Coding) contractors. Always confirm unit conversions against the current quarter's pricing files before final submission.

* Please review the full disclaimer at the bottom of this page.

Frequently Asked Questions

What is the distribution configuration for this product package?

The code 0990-7111-09 identifies a specific commercial package of 12 pouch in 1 case / 1 bag in 1 pouch / 1000 ml in 1 bag of Potassium Chloride In Lactated Ringers And Dextrose, a human prescription drug labeled by Icu Medical Inc.. This injection, solution is formulated for intravenous use and contains calcium chloride; dextrose monohydrate; potassium chloride; sodium chloride; sodium lactate as the active substance.

Is this product currently listed with the FDA?

Yes, this product is active and verified within the NDC Directory. It was introduced to the market by Icu Medical Inc. on November 25, 2019. The current certification is valid through December 31, 2027.

How is this Icu Medical Inc. product billed for insurance claims?

For medical billing and reimbursement, this package follows the 11-digit CMS format: 00990711109. Quantities are measured in per "ml or milliliter", products billed per milliliter are usually products measured by liquid volume.. The table below illustrates the segment conversion from the 10-digit labeler code to the 11-digit provider format.

11-Digit Code Conversion

Billing payers usually require a 5-4-2 segment configuration. Below is the conversion from the 10-digit package format to the 11-digit billing format:

10-Digit Format (4-4-2)
0990-7111-09
11-Digit CMS (5-4-2)
00990-7111-09

Note: The zero is added to the Labeler segment to maintain the 5-4-2 structure.