Wiki Infusion + shots

[hsmith67]

We have pt that comes in regularly for Xolair injections and we bill and are paid billing it as follows:

96372-RT
96372-LT
96372-RT/59

This pt recently came in for Reclast infusion on same date as Xolair injections. We billed as follows:

J3489 - paid by BCBS
96365 - paid by BCBS
96372-RT - DENIED
96372-LT - DENIED
96372-RT/59 - paid by BCBS

The denial on the two 96372's denied was CO-97 - This service/procedure is included in a service already paid.

Can anyone tell me how to get the entire claim paid?

Thanks for any assistance you can provide!

Hunter Smith, CPC

 

[thomas7331]

96372 bundles to 96365 under NCCI rules (my guess is that's probably to prevent billing of an injection of lidocaine given as part of the IV placement, which would be incidental). You will probably need the 59 (or XU or XS) modifier on the other two injections in order to separate them from the infusion on the same date to get proper payment for those.

 

[Mvelasquezny426]

Infusion + Mue +Modifier

Good Afternoon,

Previously we have received denials from medicare denying Codes J9047 due to # of services not supported. Claim were billed as listed below:

96375 PO 1 UNIT = PAID
80053 PO 1 UNIT= BUNDLED
82784 PO 3 UNIT = BUNDLED
83883 PO 2 UNIT = BUNDLED
82232 PO 1 UNIT = BUNDLED
86334 PO 1 UNIT = BUNDLED
85025 PO 1 UNIT = BUNDLED
96413 PO 1 UNIT =PAID
J1100 PO 8 UNIT = BUNDLED
J7050 PO 1 UNIT = BUNDLED
J9047 JG JW PO 40 UNITS= DENIED
J9047 JG PO 140 UNITS= DENIED

Can someone help me with getting this paid, would I be able to use modifier 59 on the wastage line ???
thank you for you help.

 

[Mvelasquezny426]

Infusion + Mue +Modifier

96372 bundles to 96365 under NCCI rules (my guess is that's probably to prevent billing of an injection of lidocaine given as part of the IV placement, which would be incidental). You will probably need the 59 (or XU or XS) modifier on the other two injections in order to separate them from the infusion on the same date to get proper payment for those.

Good Afternoon Thomas 7331,

Previously we have received denials from medicare denying Codes J9047 due to # of services not supported. Claim were billed as listed below:

96375 PO 1 UNIT = PAID
80053 PO 1 UNIT= BUNDLED
82784 PO 3 UNIT = BUNDLED
83883 PO 2 UNIT = BUNDLED
82232 PO 1 UNIT = BUNDLED
86334 PO 1 UNIT = BUNDLED
85025 PO 1 UNIT = BUNDLED
96413 PO 1 UNIT =PAID
J1100 PO 8 UNIT = BUNDLED
J7050 PO 1 UNIT = BUNDLED
J9047 JG JW PO 40 UNITS= DENIED
J9047 JG PO 140 UNITS= DENIED

Can someone help me with getting this paid, would I be able to use modifier 59 on the wastage line ???
thank you for you help.

 

[smanning52]

We have pt that comes in regularly for Xolair injections and we bill and are paid billing it as follows:

96372-RT
96372-LT
96372-RT/59

This pt recently came in for Reclast infusion on same date as Xolair injections. We billed as follows:

J3489 - paid by BCBS
96365 - paid by BCBS
96372-RT - DENIED
96372-LT - DENIED
96372-RT/59 - paid by BCBS

The denial on the two 96372's denied was CO-97 - This service/procedure is included in a service already paid.

Can anyone tell me how to get the entire claim paid?

Thanks for any assistance you can provide!

Hunter Smith, CPC

You will need to put a 59 modifier on the other 2 96372 codes. The LT and RT modifier are not needed with 96372.