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J codes for Hyalgan Injections and modifiers

Messages
235
Best answers
0
Re: submitting J codes
I recently got a physcian tip sheet stating that Medicare is denying claims on some of the bilateral procedures being submitted on 2 lines [RT and LT]

CMS rules now state for bilateral services should be reported on one claim line with the Modifier "50" and a unit of service as 1, to prevent these denials.

I'm also told by another biller that "J" codes do not require the modifer 50.
So, can anyone give me some input on this matter.

For example, when our patient gets bilateral Hyalgan injections in the office, this is how my claim has been going out:
J7321 RT
20610 RT
J7321 LT
20610 LT
 

madgejones10

Networker
Messages
75
Best answers
0
I have been billing like this and have been paid...

20610 LT
20610 RT / 51
J7321 (2 units)

Will be interested in what others say.
 

cluke

Networker
Messages
51
Location
Detroit
Best answers
0
We have begun to bill this:

20610- no modifier- quantity X2
J7321- no modifier- qunatity X2

This was at the request of our Medicare carrier her in Michigan.

Prior we had billed the 20610 with a 50 modifier, but had begun having problems with Medicare. We still bill it that way for all other carriers.

Hope this helps.
 

amyrose

New
Messages
3
Best answers
0
injections

I have been billing like this and we still do haven't gotten any feed back from our A/R rep for Medicare that its being denied. Curious to see what is up:

20610 50 1 unit
j7321 rt
j7321 lt
 

nrichard

Guest
Messages
254
Location
Pensacola, Fl
Best answers
0
20610
20610-51
JXXXX 2 Units

I say the 20610 on two separate line items w/out modifier 50 is because this CPT code is by nature not a bilateral code. I don't have a problem getting paid on these when they are billed like this. (Been doing ortho for 5 yrs).
 

pogiest

Guru
Messages
211
Location
Jacksonville Florida Chapter
Best answers
0
20610-LT
20610-59-RT

But...

Florida Medicare is OK with us coding bilateral injections of Kenalog/Cortisone (J3301) using 8 units for large joints and 4 units for intermediate and small joints with no modifiers, but when we bill for Hyalgan (J7321) or even Euflexxa (J7323), which we have been using a lot more than Hyalgan, they want us to bill like this…

J7323-LT
J7323-59-RT

We also bill our private carriers like this and have never had an issue.
 

mitchellde

True Blue
Messages
13,306
Location
Columbia, MO
Best answers
0
The MCM has since 2000 stated to bill bilateral procedures as one line with a 50 modifier and 1 unit. There was a notice on this back in 2000 when this policy changed. prior to this it was considered appropriate to bill as 2 lines using the 51 modifier on the second one. They did change this and a newsletter went out to all providers and the MCM was revised. I know some of you are getting paid by doing it differently however I have recently been told by those that have been billing it incorrectly, that Medicare is now requesting refunds for these as they were paid incorrectly. Just FYI.
 
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