Wiki Help J7050 Denials

[amh@yahoo.com]

Help:
Currently with our system we have to split bill our chemo services when we do multi infusions on the same day and get duplication denials on J7050 which have two different ncd numbers from bc/bs and medicare that we have to appeal. Any suggestions on how to bill or the correct billing with the scenario below? HCPC modifiers, etc any help would be appreciated.

Example::
Patients presents for chemotherapy. patient was premedicated with
aloxi Iv push 30 seconds
benadryl iv
decadron iv 10:06-10:36

herceptin iv over 30 minutes in 250cc of normal saline 10:48-11:20
taxol iv 1 hour in 250 cc of normal saline in polyethylene bag and tubing 11:34-12:34

Port flushed with normal saline and heparin patient tolerated well

1st ticket 00/01/2012
96375-59/174.9
J2649 Aloxi
J1200 benadryl
J1100 Decadrum
J9355 Herceptin
J7050 normal saline/v58.11/ncd xx
J1642 Heparin flush/v58.11
A4212 huber needle v58.11
XXXXXXXXXXXXXXXXXXXXXXX
2nd ticket 00/01/12
96417 chemo each/174.9
96367 therapeutic/174.9
J9265 Taxol
J3490 pepcid
J7050 normal saline/no pvc/polyethylene bag/V58.11/ncd xy

 

[mitchellde]

why do you split bill your infusions? this is very confusing

 

[amh@yahoo.com]

if we have more than 6 line items, i am told from our billing dept, you have to submit a multiple claim, until we go to our new practice management system

 

[mitchellde]

we always just do a page 2 rather than a multi claim as the a multi claim generally does not work and causes more back end effort than it is worth. but the claim can have multiple pages, there is a field just under the address field for page number x of y such as 1of 2 and then 2 of 2. This is the way our system always processed these. I know of no way to fix your scenario when you are billing them as 2 claims.

 

[amh@yahoo.com]

Thanks so much for your response, it is greatly appreciated.