Wiki Code J7040 should be covered 100% if billed with colorectal screening G0121

[vishal1975]

We are getting denial for code J7040 in the facility setting when billing with code G0121 and J2250 for procedure considered to be inclusive to the procedure code. Should we not be getting separate payment for J7040 as we are billing it with G0121 which is 100% covered per the PPACA guidelines for preventive screening.

 

[thomas7331]

Facilities are used paid at a case rate which includes all ancillary expenses, but this can vary depending on your payer contracts. It most likely is not a denial - it's just that the payment made on the primary line of the claim is the flat fee that covers all of the components of the procedures. I would not normally expect to see a separate itemized payment for normal saline used during a procedure.

 

[CodingKing]

I think many people misunderstand the ACA guidelines. It's only requires no cost share to the patient it doesn't require insurers actually pay extra for the service.