Wiki J100 with BCBS of LA

[2bedaisy]

I am in billing for an urgent care group in Texas. Many of our patients have Blue Cross and Blue Shield of Louisiana, and their plans invariably deny code J1100 as "invalid", even with -25 modifier appended to the E/M. Our local Blue Cross affiliate regards this as a payable code, and that is about all the information I can get from BC. Has anyone had experience with this, or have any ideas how we might get these paid?

We generally bill the J1100 with an E/M (99213 or 99214) and 96372 with a -25 modifier appended to the E/M. Most often the diagnosis is J01.90.

Thanks.

 

[ngastroent]

E/M code and J code

We're having the same issue with BCBS of MN. We kept getting denials with no real explanation as to why and when calling them, the rep wouldn't know why either. Finally got a denial last week that says even with the -25 modifier, they will not pay for an E/M code and injection/infusion for the same visit. So now can only bill the injection/infusion or the E/M code along with the drug. I'd assume it's probably the same reasoning with your denials.