Wiki J1010 160 MGS BILATERAL

[hsmith67]

So the MUE on J1010 is 120 and the provider administered 80 mg per side for 20610. BCBS Nebraska Medicare not paying anything on the J1010 due to exceeding MUE. Can someone tell me the best way to code/bill the 160 units of J1010? I'm thinking to bill 120 on one line and 40 with an SC modifier on the second line but open to suggestions.
Thanks for any help!
Hunter Smith, CPC

 

[Carol E]

There's no way to bypass the MUE edit for J1010. You'll have to appeal the denial w/ medical records. Our Medicare contractor in Texas pays us 120 and then denies the remaining 40. I've tried billing it different ways to get around it, but nothing has worked. However, all our appeals w/ medical records have been successful.

 

[CBLENNIE]

I'm thinking to bill 120 on one line and 40 with an SC modifier on the second line but open to suggestions.

According to EncoderPro for Payers Professional SC modifier is not billable with J1010. Have you tried splitting J1010 into 2 lines of 80 units each with modifiers LT, XS on one line and RT, XS on the second line to show that the medication is being injected at separate sites? Of course, you would need to bill the JZ modifier if a multidose vial was used in addition to the modifiers I mentioned above.