Wiki J codes invalid procedure code with louisiana workers com title 40

Create Wiki
S

SHERRY SCHEXNAYDER

Contributor
Messages
17
Location
Vacherie, LA
Best answers
0
I recently had a worker's compensation claim that has been denied for the use of J1885, J2001 and J1100. They have denied as invalid codes by Sedgwick CMS. and MNS. Per Title 40 of the LA WC Administration fee schedule. I used 96732 with the codes plus the NDC# of each injections to identify with a 25 modifier on the visit. When I looked up Title 40 latest edition 2014, does it want me to use 90782? That's an invalid code! I did a claim check edit on Supercoder, says to use modifier 51 on each injection. That's shows not necessary on my check edits on my Winmed software.I could some advice on how to bill to get these injections paid. I have been coding for 25+ years. Thanks in advance.View attachment DOC022.pdfView attachment DOC021.pdf
 
Last edited:
i also notice on your denial that it says if the medications is being administered from the same syringe to use the 51 modifier. Is that the case?
 
51 modifier

Thanks Donna! Treatment is not complete on this patient. She comes in weekly for these injections. I did see where modifier 51 should be used on Supercoder CMS 1500 scrubber, but my claim check edit on my software shows modifier is not necessary. I was told by Michael at MNS for Sedgwick that the J codes were invalid codes when he entered them into his system. I can do an appeal on the claims showing that the J codes are valid 2016 codes. I am going to resubmit a corrected claim with the 51 modifiers on each injection, just to see if that is the problem. My denial did not say a modifier was needed to process the claim, but will try it anyway. If not then I will file an appeal, was trying to avoid that. Thanks again.
 
You must log in or register to reply here.
Top