Go Back   AAPC Medical Coding & Billing Forums > Medical Coding > OB/GYN
Forum Rules FAQ Members List Calendar Search Today's Posts Mark Forums Read

Reply
 
Thread Tools
  #11  
Old 01-10-2013, 12:06 PM
magnolia1 magnolia1 is offline
Expert
 
Join Date: Apr 2007
Location: Albany, New York
Posts: 456
magnolia1 is on a distinguished road
Default

If you do a Forum Search for J1050, there are 2 other threads where this
issue is being discussed.
__________________
Karen Maloney, CPC
Data Quality Specialist
Reply With Quote
  #12  
Old 01-15-2013, 11:30 AM
rharmon rharmon is offline
Contributor
 
Join Date: Apr 2007
Posts: 11
rharmon is on a distinguished road
Default Depo Provera J1055

I question whether we should be using the J1050 as this represents 1mg/ml and may have a different NDC# vs the old J1055 which was 150mg/ml -
Nobody seems to have a good answer as how to bill this appropriately. Checked with Cigna and Aetna and couldn't get an answer here in Maine.
Reply With Quote
  #13  
Old 01-18-2013, 02:13 PM
tlc45801 tlc45801 is offline
New
 
Join Date: Apr 2007
Posts: 9
tlc45801 is on a distinguished road
Default

We used CPT J1050 with 150 units using a dx 625.3 on a CGS Medicare patient. The claim was processed just fine with an allowed amount on the J1050 of $30 to deduct. Fingers crossed that we have no problems with other payers!
Reply With Quote
  #14  
Old 01-21-2013, 10:21 AM
zerry1 zerry1 is offline
Contributor
 
Join Date: Apr 2007
Posts: 22
zerry1 is on a distinguished road
Default

You said you needed to use a modifier, are you applying the U1 on the claim line item J1050? The reason I ask, I was told to add the U1 to the end of my NDC# in the appropreate field on my claim. After reading your message now I'm not sure which place to apply the U1. Please clairify where you applied the U1.
Or was the U1 added by your sofeware IT agency?

Sorry for the confusion just wanna get it straight.
Thank you,
LB
Reply With Quote
  #15  
Old 01-30-2013, 01:02 PM
owenstonya owenstonya is offline
Networker
 
Join Date: Apr 2007
Posts: 41
owenstonya is on a distinguished road
Default

I am in Washington state, does the U1 modifier not apply to us?
Reply With Quote
  #16  
Old 02-07-2013, 10:57 AM
rharmon rharmon is offline
Contributor
 
Join Date: Apr 2007
Posts: 11
rharmon is on a distinguished road
Default j1055

Have called AAPC, AMA, NHIC (which the AMA told me to contact as they handle the HCPCs supposedly) and have got no where. It's like no one understands the dilemma that J1050 does not in any way shape or form equate J1055 without fudging the info i.e. NDC# but am still pursuing as I am tenacious to get to the bottom of what I think is an error in the HCPCs on someones part.
Reply With Quote
  #17  
Old 02-12-2013, 12:32 PM
owenstonya owenstonya is offline
Networker
 
Join Date: Apr 2007
Posts: 41
owenstonya is on a distinguished road
Default

Does anyone know in the state of WA if we need to use a modifier for the new depo code? I have been billing the J1050 with 150 units, but was informed some payors will not pay with that many units, it's confusing to me...
Reply With Quote
  #18  
Old 02-12-2013, 05:17 PM
Ravenlock621@aol.com Ravenlock621@aol.com is offline
New
 
Join Date: Apr 2007
Posts: 5
Ravenlock621@aol.com is on a distinguished road
Default

Thanks for the info. i will be watching closely to see what happens with payment from MCD. On another related subject, would anyone know what cpt codes to use for well woman annual gynecological exams for medicare? Medicare does not use 99384-87, or99394-97 preventive med. E&M codes. My predecessor used a regular E&M code as the visits are almost always comprehensive and involve a multitude of gyne complaints, that go well beyond a v72.31 DX code and pap smear. The major problem with this is that annual exams are exempt from deductible and co-pays, and a regular E&M code will not recognize this. Also, have they bundled the pap smear into the annual, so it is now unnecessary to keep track every 2 years for billing? Could someone give me an example of a cpt and dx coding for medicare annual exam?
Reply With Quote
  #19  
Old 02-12-2013, 05:23 PM
Ravenlock621@aol.com Ravenlock621@aol.com is offline
New
 
Join Date: Apr 2007
Posts: 5
Ravenlock621@aol.com is on a distinguished road
Default Depo & Annual Gyne exam

Thanks for the info. i will be watching closely to see what happens with payment from MCD. On another related subject, would anyone know what cpt codes to use for well woman annual gynecological exams for medicare? Medicare does not use 99384-87, or99394-97 preventive med. E&M codes. My predecessor used a regular E&M code as the visits are almost always comprehensive and involve a multitude of gyne complaints, that go well beyond a v72.31 DX code and pap smear. The major problem with this is that annual exams are exempt from deductible and co-pays, and a regular E&M code will not recognize this. Also, have they bundled the pap smear into the annual, so it is now unnecessary to keep track every 2 years for billing? Could someone give me an example of a cpt and dx coding for medicare annual exam?
Reply With Quote
  #20  
Old 03-19-2013, 12:48 PM
danadee30 danadee30 is offline
Contributor
 
Join Date: Apr 2007
Posts: 11
danadee30 is on a distinguished road
Default Depo reimbursement

I was just wondering if any of you are experiencing lower reimbursement for Medicaid and BC/BS patients when they receive Depo Provera, we have been billing J1050 with 150 units and are reimbursement this year doesn't even cover the cost of the drug we are losing money. Are any of you experiencing the same thing and if so how are you handling this to offset your costs now? It was suggested charging nurse visits when they come in for the Depo shots, having the nurse document vitals and giving information to the patient regarding the drug. I am not really comfortable doing this as I really don't feel its appropriate, but the doctors don't want to stop giving the Depo either. Thank you for your help.
Reply With Quote
Reply

Thread Tools

Posting Rules
You may not post new threads
You may not post replies
You may not post attachments
You may not edit your posts

BB code is On
Smilies are On
[IMG] code is On
HTML code is Off




Disclaimer: Although AAPC staff members will monitor these forums periodically, we cannot be responsible for the information posted herein, nor guarantee its accuracy. Our members may discuss various subjects related to medical coding, but none of the information should replace the independent judgment of a physician for any given health issue. Please note that the opinions expressed here do not necessarily reflect those of AAPC.

All times are GMT -6. The time now is 09:10 PM.

AAPC - Top

Powered by vBulletin® Version 3.8.1
Copyright ©2000 - 2014, Jelsoft Enterprises Ltd.
Copyright ©2014, AAPC