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is J3490 billable with cpt 20550?

codecrazy

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Is j3490 billable with cpt 20550 or is it bundled?:confused:
It has a n1 asc payment indicator (packaged procedure/item; no separate payment made) in Hcpcs 2008
 
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codecrazy

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surgical package

So if there:confused: :confused: :confused: is a surgery it is not payable. But if there was no surgery it can be billed?
 

donsqueen

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Who are you billing for? Physician? Hospital? Was this performed in-patient, outpatient, ASC, or office? When I coded for an office, I billed the drug. Now that I am coding for a hospital (professional services) I do not code the drug as that is billed by the facility coders.

Amy
 

mad_one80

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coding for the physician...it is billable, but may not be payable depending on the carrier...but you CAN bill the codes together since there are not CCI edits...N1 indicator means that Medicare wont pay for it.
 

melindathi

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Dont forget NDC # for J3490

Dont think anyone has mentioned an important part of J3490 rules (apologize if I overlooked & am repeating)

Injections have numerous rules per carrier so always be sure to check each carriers rules prior to billing but I am writing the basics from my exp. with billing J3490 and other J and S injection codes.

J3490 is a "junk" code meaning it doesnt have a specific NDC#
(which the NDC# is located on the packaging the bottle comes in

Since these days most meds for injections have a specific HCPCS code, be sure to verify prior to billing that code:

1. that there isnt a specific J code you should be using instead of J3490
2. if you locate a HCPCS J code, then also verify total cc/ml/mg per unit , so you dont overbill (ex. code shows 20 mg/cc or ml in description, documentation show 40cc given, then you would bill 2 units)
3. Look up the J or S code (online if you dont have a new HCPCS book) and verify the NDC#'s you have match the NDC# for that code because some J codes have more than 1 to select from dep. on concentration of medicine.
4. J and S codes change so verify the code is still valid & ensure if you locate a J or S code via searching the internet that the code is still valid via a new HCPCS book.

(20mg, 40mg & 60mg are ex. of the diff. in regards to the same name of 1 med. but if 20cc/mg/ml it may show as J1020, then a 40mg would show as J1030 and a 40mg. would have a HCPCS J code of J1040 & each of those J codes have different NDC's as a way to defientely know you have the right HCPC's code to bill)

Billing TIP:
If sending paper claims, (or if you use Medisoft) you can either:
Add the NDC# to the Local Use B field (Box 19 on the CMS form)

I use Medisoft, so I enter it either the NDC# in the patient's case on the Miscellanous tab. (local Use B field).

Most carriers will allow you to write the NDC number in Local Use B field or right above the J3490 line. So check your carriers rules to ensure accuracy.

if no J or S code is specific to medication you are giving then yes use the J3490 code:

If J3490 is the code then be sure to write total #of cc/mg or ml given to the patient per documentation as the units (J3490 is per 1cc/mg or ml per unit).


Would love other billers/coders to give their experiences with injections and any tips they have to coding/billing J or S codes correctly the first time!
 

melindathi

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Anytime(-"

Thank you for all your help. It is appreciated.
Your welcome, its just what I do 24/7 & the J codes have been an obstacle:confused: so thought best to pass on to other coders/billers to hopefully make it a little easier to get those paid.:p

Mahalo!
Melinda T.:D
 

jans04

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Is j3490 billable with cpt 20550 or is it bundled?:confused:
It has a n1 asc payment indicator (packaged procedure/item; no separate payment made) in Hcpcs 2008
I totally agree with Melindathi. Do your homework real quick to see if there is a more specific HCPCS for the Unlisted "J" code, if there is, then use it if not to report J3490 drug name, dosage and NDC# on filed 19 of the CMS1500 should be documented, regardless if the claim is hardcopy or electronic, your system should allow you to key this info in.

There is no indication in the CPT book about reporting the solultion separate from 20550 nor does it indicate if it is inclusive, so I would try appealing the denial.
 

melindathi

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CCI edits

Pretty sure it is a bundeled service (But you can check CCI's on the medicare site which shows 20550 and all codes that are considered a bundeled service when billed with that code)

What medicine are you billing for with a Trigger Point? Since all the trigger point medicine I know about now have a specific J code, so that could be where you are going wrong and why you are being denied also.

Last suggestion is check Modifiers, since another possibility is that you are missing a required modifer for 20550 is billed with certain medications.

If one of my coders knows more will write again but off the top of my head thats what I personally know(-"
Melinda
 
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