J3301 - orthopedic thread

Trendale

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Jacksonville, FL
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Hello,
Does anyone have an accurate answer and supporting CMS web links to the proper guidelines of blling J3301? There were some previous discussions that I have reviewed in the orthopedic thread, but it still was not quite clarified. I am getting denials on this J code, but not the actual procedure code(s) 20600-20610.
The denial explanation stated it needed a referring physician. My manager feels that it is something else beyond this. It really does not make sense that the procedure code and E/m code is being paid but not the J code, simply for a referring physician. Another issue that was raised was, is the J code bundled into the E/M code? The only thing so far I was able to find on the CMS Florida website is that effective May 2008, certain J codes including the J3301 will be denied w/o a valid NPI.
Does anyone have any concrete supporting links?:eek:
 

halebill

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Capital Coders, Columbia, SC
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J3301

All of my J3301's get paid (in South Carolina). The referring physician denial is odd, though. Sometimes, their denial reasons are a little mixed up (assuming we are talking about Medicare) such as the denial, "Claim lacks info" for a bad ID #. Is it just the J3301 you are having this problem with? You may want to make certain that you are sending the correct NDC #, qualifier and measure of units with it.
 

dmaec

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The J3301 should be paid..who is the carrier (just curious)? The J3301 shouldn't be bundled in with the injection - you actually shouldn't be billing/coding and injection (90772) if there is an office visit or procedure with the J3301. The "injection" is bundled in with either the procedure performed (20605/20610 or whatever) or the office visit. Also, does the office visit have a modifier .25 on it? (it's needed due to the procedure being done), hopefully it supports and E/M with the procedure.
in anycase, we get paid for J3301.
well, that's my three pennies ;)
Donna
 
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