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Hello. I am having trouble with the J2919 new code. We are adding the drug waste if applicable and JW & JZ modifier and we are still getting rejections on NDC 00009004722. Is anyone having any luck billing this code and how are you doing it?
Yes of course. Here is the denial: THE CODE J2919 AND NDC CODE 00009004722 SUBMITTED ARE NOT A VALID COMBINATION. and it is being billed with J2919 JZ - 20 units (ndc listed earlier with .80 UN) then the J2919 JW - 5 units ( with .20 UN on ndc). The payer is BCBS of MN. I have checked over there payer guidelines news updates and nothing is listed. I confirmed all of this information on the RC claims assist website.
Per the NDC you listed, this is a 125 mg vial. First thing I see is the JZ and JW aren't used together when the drug is from the same vial. You want to remove the JZ on the 20 unit line. There is clearly waste from that vial or you wouldn't be billing the additional 5 units. The JW on the 5 unit line is correct.
As to the invalid combo denial: since the code is new, the payer likely doesn't have the NDC linked to the HCPCS code so I would submit a photocopy of the box (if you can get) showing the NDC from the packaging that you're using OR the prescribing information and something from CMS showing the J2919 effective date. I posted the link to the CMS HCPCS quarterly updates page on another thread.