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Kenalog Injections

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HeatherCorum

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New Market, AL
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Every time we bill a Kenalog injection it is being denied. For example with Medicare, we do J3301.RT 16 units and we do the same with the left side J3301.LT. We also bill the 20610.rt 20610.LT. Medicare's denial reason is "payment adjusted because the payer deems the information submitted does not support this many/frequency of services." Medicare Adv policies deny as well. Is it the units?! What are we missing? Thanks in advance!
 
16 units of J3301 would be 160 mg of Kenalog (on each side). That's a lot. Are you calculating this by mg of Kenalog, or ml or cc (volume of injection)? The error message suggests that this is not a medically necessary dosage.... too much.
 
Pam Warren said:
16 units of J3301 would be 160 mg of Kenalog (on each side). That's a lot. Are you calculating this by mg of Kenalog, or ml or cc (volume of injection)? The error message suggests that this is not a medically necessary dosage.... too much.
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When the claim originally went out the biller entered just 1 unit and we got the same denial. Then when I went back to look to see what they billed the second time they changed it to 16 units. I read the dictation from the provider and the patient got 40mgs on each side, which means our units should only be 4 correct?
 
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