Wiki Q4236/15275 help please

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caddellheather@yahoo.com

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Hello. We are new to billing Q4236 and are being told by the supplier that we are fine to bill this with the application of the skin graft 15275. Anthem is bundling the code though and I am curious if anyone has seen this. If so, what modifier are you using or is this correct and we should consider the skin graft part of the Q4236? Any suggestions or help would be greatly appreciated. Thanks!
 
Q4236 is the biological product and 15275 is the application. They should be payable separately. Are you billing with any other codes? Are you using the J modifier and what dx are you billing?
 
We originally billed Q4236 with the JZ modifier, but the rep told us that if that denied, which it did, that we needed to remove that. Anthem denied the Q4236 stating that the JZ was an inappropriate modifier for the service. Also we are billing with DX L97.522 (non pressure chronic ulcer of other part of left foot with fat layer exposed)
 
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Check Anthem LCD policy also.
Most skin subs are payable by Medicare and very few by the commercial companies. These companies will tell you it's payable and then it is listed as investigational on the LCD policy.

Your office will need to have a billing aide contact at the distributor and communication in writing so you can get your account credited for the product if they advised it was payable.
 
Sheri24sm said:
Check Anthem LCD policy also.
Most skin subs are payable by Medicare and very few by the commercial companies. These companies will tell you it's payable and then it is listed as investigational on the LCD policy.

Your office will need to have a billing aide contact at the distributor and communication in writing so you can get your account credited for the product if they advised it was payable.
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Thank you.
 
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