Denials Humana Help

perkins05

Expert
Messages
296
Location
New Orleans
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0
Hem/ONCo---denial states qualifying service/procedure needed

codes

96413
96415
96367
96366
j2469 9:20-10:40
j2920 9:40- 10:00
j2780 10:00-10:20
J1453 10:40-11:15
J9310 11:15-3:00

cpt book states that 96413 and 96367 can be used together. Is anyone else getting this denail?
 
Last edited:

ajs

True Blue
Local Chapter Officer
Messages
1,086
Location
Tacoma, WA
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Hem/ONCo---denial states qualifying service/procedure needed

codes

96413
96415
96367


cpt book states that 96413 and 96367 can be used together. Is anyone else getting this denail?
They can be used together, but the 96367 is supposed to be billed with 96365 first, for the first hour of the IV infusion for therapy, diagnosis or prophylaxis. Need to know what type of drug is being infused and why before we can really evaluate the denial.
 

btadlock1

Guest
Messages
1,504
Location
Lubbock, TX
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Hem/ONCo---denial states qualifying service/procedure needed

codes

96413
96415
96367


cpt book states that 96413 and 96367 can be used together. Is anyone else getting this denail?
I don't see any reason you shouldn't be able to bill those CPT's - you could have the chemo as the primary procedure. Humana's kind of weird about making sure that the J-codes are on the same claim form as the admin codes, though - have you called them to get more information about the denial?
 
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