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J3301 Rejection - I have a claim that is being rejected
- Thread starter aklunder
- Start date
RonMcK3
Guru
TC?
Are you sure about the TC modifier on your Radiologic examination, shoulder; complete, minimum of 2 views? I was expecting to see a 26, Professional Component, not a TC, Technical Component.
Are you sure about the TC modifier on your Radiologic examination, shoulder; complete, minimum of 2 views? I was expecting to see a 26, Professional Component, not a TC, Technical Component.
RonMcK3
Guru
Okay, who is billing the professional component? If your doc owns the radiologic equipment, wouldn't you bill the procedure with no modifier(s)? Or is someone else (different NPI) doing the interpretation and report? Or is the professional component considered to be part of the E/M? (I'm new so this is all going towards educating me.)
Might their challenge with the RT modifier? Using it shouldn't make any difference but might it be tripping up the edit?
Might their challenge with the RT modifier? Using it shouldn't make any difference but might it be tripping up the edit?
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mitchellde
True Blue
Did you include the NDC number on the claim?
Please be advised that your practice may now see claims in hold with the following claim note: “CMS is requiring a description of services provided for all CPT lines where the procedure code is a not otherwise specified code. Please review these claims for any CPT lines where the procedure code description in CodeCorrect contains text such as "Not otherwise specified" or "Not otherwise classified." For all such lines, please add a line note describing the unlisted procedure code and resubmit the claim.
https://www.cms.gov/ElectronicBillingEDITrans/40_FFSEditing.asp
You will need to put a description in the edit box on the claim. example - Kenalog 10 mg
https://www.cms.gov/ElectronicBillingEDITrans/40_FFSEditing.asp
You will need to put a description in the edit box on the claim. example - Kenalog 10 mg
Last edited:
Herbie Lorona
Expert
I believe it is a 5010 edit. I would contact either Medicare or maybe your clearing house to see if they can give you info on how to get it corrected
East Coast
Guest
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First, when billing an any x-ray for a SNF patient you need to apply to -26 modifier to the procedure code and ONLY if your office pays your x-ray technician and owns the equipment, can should you bill the -TC modifier with the procedure code directly to the SNF.
Regarding the denial for the J3301, it also sounds to me that this denial may be tied to the 5010 edits. We too are having trouble with our claims getting to Medicare, but this is due to our software not being 5010 compliant. Good news is our update is coming next week!
I would double check with your Clearinghouse to see what rejection they are receiving on their end. They should definitely be able to tell you!
Hope this helps!
** I also posted a question yesterday regarding "New Patient Consults" would love to have to look for that and what your opinion is! **
Regarding the denial for the J3301, it also sounds to me that this denial may be tied to the 5010 edits. We too are having trouble with our claims getting to Medicare, but this is due to our software not being 5010 compliant. Good news is our update is coming next week!
I would double check with your Clearinghouse to see what rejection they are receiving on their end. They should definitely be able to tell you!
Hope this helps!
** I also posted a question yesterday regarding "New Patient Consults" would love to have to look for that and what your opinion is! **
Ldari
Networker
We are also getting the same rejections. Could anyone else tell me what they add in the NOC description? For example with J3301, we have "Kenalog" as the description but I'm wondering if they need more... Should we add "Kenalog-40 80mg" instead? or? Any help is appreciated.
procedure description required by medicare
I had the same issue with all my medicare claims. J3301 is one of the "unspecified" HCPCS codes that now require a description. I went to edit mode on my clearinghouse (zirmed) and added "KENALOG 10MG" in the "procedure description" field on the general tab for that line.
I had the same issue with all my medicare claims. J3301 is one of the "unspecified" HCPCS codes that now require a description. I went to edit mode on my clearinghouse (zirmed) and added "KENALOG 10MG" in the "procedure description" field on the general tab for that line.
mzblackmon12@gmail.com
Networker
J3301
When you went into clearing house and did the edit to show kenalog 10mg, did the claim go through???
Lisa Fisher, CPC
Daphne, AL
When you went into clearing house and did the edit to show kenalog 10mg, did the claim go through???
Lisa Fisher, CPC
Daphne, AL
mitchellde
True Blue
Did you use the N4 qualifier in front of the NDC number? when you are done the number you submit should be a total of 13 characters with no dashes or spaces starting with N4. You also need the UN, or GR or ML pacaging code from the package and the number such as UN2 or gr40
After I added the description for the procedure "KENALOG 10MG" the claim went thru. Per the medicare website, the HCPCS codes that have "unspecified" or "not otherwise specified" in the description, have to show the description of the drug. The 2012 HCPCS code manual says "use this code for Kenalog 10; Kenalog 40; Tri-Kort; Kenaject 40; Genacort A40; Triam-A; Trilog"; so you have to tell medicare which drug/dosage is in the shot. Medicare paid our claims after I added the description.
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J3301 denials
We are also getting rejections for Kenalog. Any help would be appreciated.
We are also getting rejections for Kenalog. Any help would be appreciated.
J3301 requires procedure description for medicare
After I edited my claims and added the procedure description for J3301 (KENALOG 10MG) they were accepted & paid. Here's the Medicare rejection reason pasted from Zirmed.
" PAYER PROCEDURE DESCRIPTION IS REQUIRED FOR UNSPECIFIED CODES. "
The NDC code was not the issue - they give a different rejection reason for NDC's
After I edited my claims and added the procedure description for J3301 (KENALOG 10MG) they were accepted & paid. Here's the Medicare rejection reason pasted from Zirmed.
" PAYER PROCEDURE DESCRIPTION IS REQUIRED FOR UNSPECIFIED CODES. "
The NDC code was not the issue - they give a different rejection reason for NDC's
shayna5184
New
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Did anyone find out anything regarding the J3301 rejections because Medicare isn't processing my J3301 claims. Help!!
Herbie Lorona
Expert
What reason are you getting from Medicare for them not processing the J3301?
shayna5184
New
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This is the rejection:
02/18/2013 - 277 GA MEDICARE REJECTION REPORT
Payer : Entity acknowledges receipt of claim/encounter Acknowledgement/Receipt J3301
Detailed description of service Acknowledgement / Rejected for relational field in error.'
Payer : Entity acknowledges receipt of claim/encounter Acknowledgement/Receipt
Where do you place the descriptor on the HCFFA?
02/18/2013 - 277 GA MEDICARE REJECTION REPORT
Payer : Entity acknowledges receipt of claim/encounter Acknowledgement/Receipt J3301
Detailed description of service Acknowledgement / Rejected for relational field in error.'
Payer : Entity acknowledges receipt of claim/encounter Acknowledgement/Receipt
Where do you place the descriptor on the HCFFA?