Wednesday, April 6, 2011

CPT J3301, J3420 - FILING OF J CODES WITH NDC#

DESCRIPTION OF THE ISSUE

Medicaid requests NDC# for CPTs J3420 and J3301.  Initially we have incorrectly filed claims without NDC# and they were denied for requests of NDC# update.

CONCEPT

All J codes should be filed with NDC# updates for Medicaid.

SOLUTION

We requested NDC# update from the Client by compiling the list of denied claims.  For which we received NDC# as 005-170-03125 only for CPT J3420.  Claims that were denied for the given procedure were refiled with appropriate NDC# and got paid.  NDC# request for CPT J3301 is still in pending on the table of Dr’s office.


Triamcinolone Acetonide Kenalog  10mg INJ J3301  

Vitamin B12 o Cyanocobalamin  1000mcg IM/SC J3420 


BILLING Guide for CPT J3301

NOTE: When giving injectable medications in the office, make sure your doctor is letting the billing department know how many Milligrams not how many CCs they are giving.


EXAMPLES

J3301 Kenalog is billed out per 10 mg If you gave 40 mg, it would be billed as J3301 x 4 units
J1885 Toradol is billed out per 15 mg If you have 30 mg, it would be billed as J1885 x 2 units
J0696 Rocephin is billed out per 250 m  If you have 1 g, it would be billed as J0696 x 4 units


The CPT code J3301, Kenalog injection is a good example of an NOC code that must be used. Read the user manual for instructions for submitting NDC numbers. You need to change your insurance layout and enter the NDC number using the format specified in the user manual.

To report the Kenalog, use the HCPCS code J3301. This J code is for triamcinolone acetonide per 10mg. The instructions for this code state to use for Kenalog- 10, Kenalog-40, Triam-A. This code may be billed in multiple units. Thus, if 20mg were used, report J3301 with 2 in the units box (box 24G on the CMS -1500 form).



Guidelines related to Maximum Units

Procedure codes have been assigned a maximum number of units that may be billed per day for a member,  regardless of the provider. When a provider bills a number of units that exceeds the daily assigned allowable unit(s) for that procedure, the excess units will be denied. Some procedure codes have been assigned a maximum number of units that may be billed within a 12 month period for a member. Those services would not be done more than once within a year, or twice a year for bilateral procedures. If a provider bills a number of units that exceed the annual assigned allowable unit(s) for that procedure for a member, the excess units will be denied. 

Anatomical modifiers E1-E4 (Eyes), FA-F9 (Fingers), and TA-T9 (Toes) have a maximum allowable of one unit per anatomical site for a given date of service. Any service billed with an anatomical modifier for more than one unit of service will be adjusted accordingly. Certain obstetrical diagnostic services may have assigned maximum units per day limits based upon presence or absence of diagnosis codes indicative of multiple gestation. Units billed in excess of the maximum per day  limits will be denied.

Team surgery and co-surgery maximums are handled separately and are edited based on the same provider, not at the member level. When the same provider bills a number of units of team surgery or co-surgery that  exceed the daily assigned allowable unit(s) for that procedure for the same member, the excess units will be
denied.

Each claim line is adjudicated separately against the maximal units of the code on that line. Blood glucose test or reagent strips (A4253) is limited to 20 units (boxes) per quarter for patients with insulin dependent diabetes, and 6 units (boxes) per quarter for patients with non-insulin dependent diabetes. Per unit reimbursement for allergy immunotherapy is based on the number of dosages prepared and intended for administration. Allergy immunotherapy is limited to 180 units for the first year of therapy during escalation, and 120 units for yearly maintenance therapy thereafter.

Multi-lead collimator (MLC) device(s) for intensity modulated radiation therapy (IMRT), design and construction per IMRT plan (CPT 77338) is reported once per IMRT plan and is limited to 3 units per 60 day treatment course.


In the unusual clinical circumstance when the number of units billed on the claim exceeds the assigned maximum number for that procedure, clinical documentation of the number of units actually performed could be submitted for reconsideration. 

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