Wiki J3301 Kenalog Denied

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J3301 Kenalog Denied

They are covered based on the diagnosis, the number of times injected, and how far apart they are injected. Remember: You cannot charge an office level to administer an injection, such as 99211 Office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician or other qualified health care professional. Usually, the presenting problem(s) are minimal. Typically, 5 minutes are spent performing or supervising these services.
Also, if the op report says “10cc of Lidocaine was injected into scar along with 40mg Kenalog,” and you bill for Kenalog (J3301 Injection, triamcinolone acetonide, not otherwise specified, 10 mg) with CPT® 96372 Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intramuscular, you cannot bill for the lidocaine. It was given for comfort and not billable. You can only bill for the Kenalog and the administration. The lidocaine is an integral component of the administration of the Kenalog and is not additionally reimbursable.

cwilson3333

Expert
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266
Location
Hamilton, VA
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Medicare is denying the kenalog code J3301, which I am billing with the NDC # and
dosage. My AR person is telling me Medicare is denying for "wrong description" of
code. I have not seen the EOB, but any ideas on the denial as wrong description.

Thanks,

Cw
 

grth97

Networker
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40
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All unlisted/not otherwise specified codes must have a desription in edit line note on the claim. So for example, for J3301 we put "triamcinolone acetonide 10mg" in the edit line note. :)
 
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J3301

I am having the same difficulty. After several phone calls with Trailblazer Health (J4 Medicare Contractor), it boils down to needing that description in Loop 2300 or 2400, Segment NTE01 and NTE02. Now my software vendor is looking into it, because whatever they are sending is not following the crosswalk to those Loops and segments. We have tried placing it everywhere we can think of in the claim entry.

As a side note, if you look up the "Part B Ask-the-Contractor Teleconference
Questions and Answers,June 13, 2012" You get this!
Question:
We are having trouble with injection charges, primarily B12 (J3420) and Kenalog® (J3301). I understand B12 is a non-covered benefit, but I thought Kenalog® was covered. Also, what is the proper way to charge for these services with administrative fees, nurse's visit, etc?
Answer:
Vitamin B12 (J3420) and Kenalog® (J3301) are non-covered by Medicare. The administration fee is non-covered if the drug is non-covered.

!!! I called Medicare and was told that it was covered, so who really knows the answer to this????
 

mitchellde

True Blue
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13,538
Location
Columbia, MO
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They are covered based on the diagnosis and number of times injected and how far apart they are injected. Also you cannot charge an office level to administer an injection such as a 99211.
 

emmieg1@yahoo.com

Networker
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28
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J3301 Kenalog

In our facility we use ECW software and how we enter it in order for our clearing house not to rejected it is as follows:

1. Reports
2. Reports Console
3. Under Billing click on Additional claim data/options
4. Enter claim #
5. Hilite the line that has the J3301
6. click on update ( should be on the right)
7. hilite description, copy, and paste on the window below, ok.
 

ollielooya

True Blue
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900
Location
Everett, WA
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I've been dealing with similar issues, only have come to find out that it involved an updated NDC code and our software did not reflect the new changes. Don't know if this would apply to your situation, but was furnished the correct NDC number, updated the system, and now the line item J codes are once again being processed and paid.
 

erjones147

Expert
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399
Location
Fernley, NV
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Medicare is denying the kenalog code J3301, which I am billing with the NDC # and
dosage. My AR person is telling me Medicare is denying for "wrong description" of
code. I have not seen the EOB, but any ideas on the denial as wrong description.

Thanks,

Cw
I have a similar problem with J3301, but only when billing Medicare. Our workaround is just to wait until the claim rejects via the clearinghouse, then edit the claim manually and put in the correct descriptor, and then re-send electronically
 

npricercm

Guest
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If the physician documents:
used 6 cc of 4 mg kenalog.
How can we bill the code?
Try putting the descriptor in block 19 of the HCFA. We found out our billing software wasn't transmitting it on the file. When that is fixed, at least all the information will be at the payor.
 
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