Wiki J7321 or J3490

[g.fairchild]

Hello All....

I am a bit perplexed at the moment. My Docs have been giving what I thought were Hyalgan injections. They are injecting a compounded Hyaluronic Acid, although in both charge slip and dictation they are stating Hyalgan...that is what we billed (J7321) and what we were reimbursed for from several Payers.

Has anyone else out there used these compounded versions....and what is notated on the Charge Slip/Dictation on these visits...

I am thinking I am going to have to rebill all of these with the J3490, and copies of the invoices...

Any opinions would be GREATLY appreciated. My Nurse Clinician tells me the nursing staff does not understand the NDC #'s and they only refer to these drugs by the brand name???? HELP!!!!!

 

[Walker22]

My physicians have never used a compounded version, but I agree that J3490 would be the code to use. J7321 is for pre-packaged Supartz.

 

[brockorama01]

I've never heard of compounded Hyalgan. Is it coming from a specialty pharmacy or a pharmaceutical company? When in doubt, call the drug rep you buy it from. Since you won't buy their drug if you can't get paid for it, they generally have lots of helpful info on coding.

Brock Berta, CPC
Billing Czar

 

[g.fairchild]

It's coming from a compounding pharmacy who is using, what he states, the exact same formulary as Hylagan (only much cheaper)...the problem is the NDC, no payers have this on their lists, and it is considered J3490 from what I understand...it is not on the FDA wbsite either.

 

[brockorama01]

This one of those funny little healthcare quandries. The office can get the stuff cheaper from a private pharmacy but runs the risk of being paid less. The net result is the same or worse net profit.

Its a cost benefit thing. If the savings is big and you don't do a lot, it may be worth the hassle of sending invoices, appealing denials...and appealing some more.