Wiki 96413 Medicare denial

[sande78705]

Does any one have any information regarding the 96413 administration code? We have been billing MCR 96413 with J0890 and J7030 and are being denied with the reason that the service is not billed separately and missing/incomplete/invalid procedure codes. Some one suggested that the chemo therapy should use a 96375 instead. We had been paid earlier in the year and stating in March 2014 MCR started to deny it.
Thanks for the input
Suzanne

 

[alannae]

96413 is not the correct admin code for that drug. The correct code would be either 96365 or 96374 depending on the start and stop times for the admin (the length of time it took to administer the drug). Can you provide more information?

Also, the J7030 is included with the administration of the drug. It is not separately billable/payable.

Alanna

 

[sande78705]

I meant to say that we needed to use the 96365 not 75, but we do bill J7030 and get reimbursed. There are other medications that we infuse. Unfortunately, I can't get me hand on the patient I was referencing to provide additional information. Thanks for the info