Wiki Denials Humana Help

[perkins05]

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?

 

[ajs]

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.

 

[perkins05]

Thanks for responding Arlene.

Drugs used

j1200
j2790
j9310
j2505

 

[btadlock1]

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?

 

[jrclark1987@yahoo.com]

I received a Denial today from Humana Medicaid (Humana Healthy Horizons state KY). I have searched for 3 hours for this specific policy. Does anyone have experience and knowledge with this? thank you.
Remark Z6%
PAYMENT FOR THIS CO-SURGERY SERVICE IS NOT ALLOWED WHEN BILLED FOR A KENTUCKY
MEDICAID MEMBER. THE MEMBER IS NOT RESPONSIBLE FOR PAYMENT.