Wiki Insurance and Study billing -

[CFisher5]

We are giving a patient three drugs, part gets billed to the insurance and part of it gets billed to a study. J9999 (Drug-X supplied by the study), J9305 (billed to the insurance), and J2405 (paid for by the study). The claim should look like this if they were all going together:

J9999 x 1 ($0 amount)
J9305 x 90
J2405 x 12
96413 (for J9999)
96417 (for J9305)
96367 (for J2405)

Since only the J9305 is being billed to the insurance, how am I supposed to bill these codes? I can't bill an add on code without an initial to the insurance, and it is definitely not correct to bill an initial infusion code to both the study and the insurance. Does anyone have any ideas? The study has no idea how to bill it out either so I am a little stuck on this. Any input is appreciated. Thanks.

 

[lenachristine87]

For our study patients the administrations are not covered by the study so they are billed to the insurance carrier. We use ICD-9 V70.7 and modifier Q0 or Q1 where appropriate.

 

[CFisher5]

For our study patients the administrations are not covered by the study so they are billed to the insurance carrier. We use ICD-9 V70.7 and modifier Q0 or Q1 where appropriate.

I understand that I do the same... but I can't bill an initial for both drugs and the initial drug is the study drug. So I would have to bill the initial to the study and then bill the add-on code by itself to the insurance. We all know that wont end well lol. Any thoughts?