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Wiki J3301 Rejection - I have a claim that is being rejected

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aklunder

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I have a claim that is being rejected by Medicare stating J3301 is "rejected for relational field in erro, check detailed description of service". What does this mean?

It is being billed with a 99214-25,20610-LT, and 73030-TC. Any ideas???
 
TC?

Are you sure about the TC modifier on your Radiologic examination, shoulder; complete, minimum of 2 views? I was expecting to see a 26, Professional Component, not a TC, Technical Component.
 
Yes, we're billing the technical component of this. I don't think this would have any impact on the J3301.
 
Okay, who is billing the professional component? If your doc owns the radiologic equipment, wouldn't you bill the procedure with no modifier(s)? Or is someone else (different NPI) doing the interpretation and report? Or is the professional component considered to be part of the E/M? (I'm new so this is all going towards educating me.)

Might their challenge with the RT modifier? Using it shouldn't make any difference but might it be tripping up the edit?
 
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aklunder said:
I have a claim that is being rejected by Medicare stating J3301 is "rejected for relational field in erro, check detailed description of service". What does this mean?

It is being billed with a 99214-25,20610-LT, and 73030-TC. Any ideas???
Click to expand...

Did you include the NDC number on the claim?
 
Please be advised that your practice may now see claims in hold with the following claim note: “CMS is requiring a description of services provided for all CPT lines where the procedure code is a not otherwise specified code. Please review these claims for any CPT lines where the procedure code description in CodeCorrect contains text such as "Not otherwise specified" or "Not otherwise classified." For all such lines, please add a line note describing the unlisted procedure code and resubmit the claim.

https://www.cms.gov/ElectronicBillingEDITrans/40_FFSEditing.asp

You will need to put a description in the edit box on the claim. example - Kenalog 10 mg
 
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I believe it is a 5010 edit. I would contact either Medicare or maybe your clearing house to see if they can give you info on how to get it corrected
 
First, when billing an any x-ray for a SNF patient you need to apply to -26 modifier to the procedure code and ONLY if your office pays your x-ray technician and owns the equipment, can should you bill the -TC modifier with the procedure code directly to the SNF.

Regarding the denial for the J3301, it also sounds to me that this denial may be tied to the 5010 edits. We too are having trouble with our claims getting to Medicare, but this is due to our software not being 5010 compliant. Good news is our update is coming next week!

I would double check with your Clearinghouse to see what rejection they are receiving on their end. They should definitely be able to tell you!

Hope this helps!

** I also posted a question yesterday regarding "New Patient Consults" would love to have to look for that and what your opinion is! **
 
We are also getting the same rejections. Could anyone else tell me what they add in the NOC description? For example with J3301, we have "Kenalog" as the description but I'm wondering if they need more... Should we add "Kenalog-40 80mg" instead? or? Any help is appreciated.
 
We are experiencing the same issue with J3301. I've already resubmitted with the NDC and am still getting a rejection. If anyone gets to the bottom of this, it would be helpful to hear what you find out.
 
procedure description required by medicare

I had the same issue with all my medicare claims. J3301 is one of the "unspecified" HCPCS codes that now require a description. I went to edit mode on my clearinghouse (zirmed) and added "KENALOG 10MG" in the "procedure description" field on the general tab for that line.
 
tbolla said:
We are experiencing the same issue with J3301. I've already resubmitted with the NDC and am still getting a rejection. If anyone gets to the bottom of this, it would be helpful to hear what you find out.
Click to expand...

Did you use the N4 qualifier in front of the NDC number? when you are done the number you submit should be a total of 13 characters with no dashes or spaces starting with N4. You also need the UN, or GR or ML pacaging code from the package and the number such as UN2 or gr40
 
After I added the description for the procedure "KENALOG 10MG" the claim went thru. Per the medicare website, the HCPCS codes that have "unspecified" or "not otherwise specified" in the description, have to show the description of the drug. The 2012 HCPCS code manual says "use this code for Kenalog 10; Kenalog 40; Tri-Kort; Kenaject 40; Genacort A40; Triam-A; Trilog"; so you have to tell medicare which drug/dosage is in the shot. Medicare paid our claims after I added the description.
 
J3301 requires procedure description for medicare

After I edited my claims and added the procedure description for J3301 (KENALOG 10MG) they were accepted & paid. Here's the Medicare rejection reason pasted from Zirmed.
" PAYER PROCEDURE DESCRIPTION IS REQUIRED FOR UNSPECIFIED CODES. "

The NDC code was not the issue - they give a different rejection reason for NDC's
 
Did anyone find out anything regarding the J3301 rejections because Medicare isn't processing my J3301 claims. Help!!
 
This is the rejection:

02/18/2013 - 277 GA MEDICARE REJECTION REPORT
Payer : Entity acknowledges receipt of claim/encounter Acknowledgement/Receipt J3301
Detailed description of service Acknowledgement / Rejected for relational field in error.'
Payer : Entity acknowledges receipt of claim/encounter Acknowledgement/Receipt


Where do you place the descriptor on the HCFFA?
 
J3301 falls under the Unclassified Drug and Medicare requires the description in the NOC code description - this is why the claim is either denying or rejecting at the clearinghouse (Injection, triamcinolone acetonide, not otherwise specified, 10mg) - Medicare does not accepted HCFA but if billing HCFA this will go in Box 19 and Electronic - Because you stated Medicare of GA please refer to this link for the Loop and segment https://www.palmettogba.com/palmetto/jjb.nsf/DID/AW8MMP6652 - Also just a note this is fall all Medicare jurisdiction for this J code - In my system I have this description Hard coded at the CPT so the description always goes out.
 
midnight1995 said:
J3301 falls under the Unclassified Drug and Medicare requires the description in the NOC code description - this is why the claim is either denying or rejecting at the clearinghouse (Injection, triamcinolone acetonide, not otherwise specified, 10mg) - Medicare does not accepted HCFA but if billing HCFA this will go in Box 19 and Electronic - Because you stated Medicare of GA please refer to this link for the Loop and segment https://www.palmettogba.com/palmetto/jjb.nsf/DID/AW8MMP6652 - Also just a note this is fall all Medicare jurisdiction for this J code - In my system I have this description Hard coded at the CPT so the description always goes out.
Click to expand...
Thank you, that link is very helpful.
 
Hi all ! I am getting the clearinghouse rejection NOC required for J3301. I added triamcinolone 80 mg injection and still rejected . Do I need to put NOC Kenalog 80 mg injection ?
 
mfm1988 said:
Hi all ! I am getting the clearinghouse rejection NOC required for J3301. I added triamcinolone 80 mg injection and still rejected . Do I need to put NOC Kenalog 80 mg injection ?
Click to expand...
Did you ever find a solution and get this paid? We are currently having this issue. Whether is is Kenalog 10mg per unit or Triamcinolone acetonide 10 mg per unit, the claim is still being denied for "NON-SPECIFIC HCPC/CPT CODES REQUIRE SERVICE LINE DESCRPRIPTION J3301)
 
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