Wiki Qutenza J7336 application CPT/HCPCS

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sarah8873

sarah8873

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I am a facility coder for a hospital system that is primarily Medicare and Medicaid patients. I also work denials, NCCI edits, payer specific edits etc for OPPS billing. Our pain management and wound care clinics want to start using and charging for Qutenza capsaicin patches and application.

These patches require provider application and monitoring for 30-60 minutes depending on reason for use. I have foudn some documentation that shows J7336 is a billable charge, but I can't find anything regarding charge for the application. The only document that has any suggestions is the Qutenza reimbursement guide which has 64620, 64632, 64999, and 64640.

Our clinic wants to use 64999. However, I don't see that this is going to be reimbursed by Medicare or Medicaid as they seem to always have an issue with the unlisted codes but the others don't seem quite right either.

I could not find any payer policies on this nor was there any concrete or even suggestive information on any CMS articles that I was able to find. I found one statement regarding 64999 on an LCD article that I interpret as not covered for these patches.

I did find one that suggested 64999 or 96999 from Blue cross and then another suggesting additional E/M charge.

We only code and bill facility charges so we only use one standard E/M code and don't have the option of using a higher level E/M.

Basic procedure:
Requires use of topical anesthetic, correct application, pt monitoring for BP, comfort ie cold pack or analgesic medication.
Removal after 30 minutes for DM ulcer and 1 hour HPN by provider.


I was just wondering if anyone has any experience with this and/or suggestions for a procedure code to capture this service as this is a high dollar product ($1,596)

We bill 510 rev G0463 for Medicare and some Medicaid (new policy) and 99213 for all other payers (which is usually adjusted off as they don't pay facility charges for office visits.)

Per UB04 editor is 636 is the only allowed rev code. If I try to bill this with just the 636 and J7336, I think we are just going to get it back as incidental due to no pass through charge edit.

Basic procedure
Requires use of topical anesthetic, correct application, pt monitoring for BP, comfort ie cold pack or analgesic medication.
Removal after 30 minutes for DM ulcer and 1 hour HPN by provider.


I was just wondering if anyone has any experience with this and/or suggestions for a procedure code to capture this service as this is a high dollar product ($1,596)
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sarah8873 said:
I am a facility coder for a hospital system that is primarily Medicare and Medicaid patients. I also work denials, NCCI edits, payer specific edits etc for OPPS billing. Our pain management and wound care clinics want to start using and charging for Qutenza capsaicin patches and application.

These patches require provider application and monitoring for 30-60 minutes depending on reason for use. I have foudn some documentation that shows J7336 is a billable charge, but I can't find anything regarding charge for the application. The only document that has any suggestions is the Qutenza reimbursement guide which has 64620, 64632, 64999, and 64640.

Our clinic wants to use 64999. However, I don't see that this is going to be reimbursed by Medicare or Medicaid as they seem to always have an issue with the unlisted codes but the others don't seem quite right either.

I could not find any payer policies on this nor was there any concrete or even suggestive information on any CMS articles that I was able to find. I found one statement regarding 64999 on an LCD article that I interpret as not covered for these patches.

I did find one that suggested 64999 or 96999 from Blue cross and then another suggesting additional E/M charge.

We only code and bill facility charges so we only use one standard E/M code and don't have the option of using a higher level E/M.

Basic procedure:
Requires use of topical anesthetic, correct application, pt monitoring for BP, comfort ie cold pack or analgesic medication.
Removal after 30 minutes for DM ulcer and 1 hour HPN by provider.


I was just wondering if anyone has any experience with this and/or suggestions for a procedure code to capture this service as this is a high dollar product ($1,596)

We bill 510 rev G0463 for Medicare and some Medicaid (new policy) and 99213 for all other payers (which is usually adjusted off as they don't pay facility charges for office visits.)

Per UB04 editor is 636 is the only allowed rev code. If I try to bill this with just the 636 and J7336, I think we are just going to get it back as incidental due to no pass through charge edit.

Basic procedure
Requires use of topical anesthetic, correct application, pt monitoring for BP, comfort ie cold pack or analgesic medication.
Removal after 30 minutes for DM ulcer and 1 hour HPN by provider.


I was just wondering if anyone has any experience with this and/or suggestions for a procedure code to capture this service as this is a high dollar product ($1,596)
View attachment 5643
View attachment 5642

Click to expand...
NGS our MC in CT sent out a notification to use 17999 and they will analog to 17360. file:///C:/Users/Desktop/Quetenza-%20NGSMEDICARE.html
 
Wondering if there's a consensus yet on the most appropriate application/administration code for the Qutenza patch. Manufacturer suggests 64999, Medicare suggests 17999. Any suggestions?
 
sarah8873 said:
I am a facility coder for a hospital system that is primarily Medicare and Medicaid patients. I also work denials, NCCI edits, payer specific edits etc for OPPS billing. Our pain management and wound care clinics want to start using and charging for Qutenza capsaicin patches and application.

These patches require provider application and monitoring for 30-60 minutes depending on reason for use. I have foudn some documentation that shows J7336 is a billable charge, but I can't find anything regarding charge for the application. The only document that has any suggestions is the Qutenza reimbursement guide which has 64620, 64632, 64999, and 64640.

Our clinic wants to use 64999. However, I don't see that this is going to be reimbursed by Medicare or Medicaid as they seem to always have an issue with the unlisted codes but the others don't seem quite right either.

I could not find any payer policies on this nor was there any concrete or even suggestive information on any CMS articles that I was able to find. I found one statement regarding 64999 on an LCD article that I interpret as not covered for these patches.

I did find one that suggested 64999 or 96999 from Blue cross and then another suggesting additional E/M charge.

We only code and bill facility charges so we only use one standard E/M code and don't have the option of using a higher level E/M.

Basic procedure:
Requires use of topical anesthetic, correct application, pt monitoring for BP, comfort ie cold pack or analgesic medication.
Removal after 30 minutes for DM ulcer and 1 hour HPN by provider.


I was just wondering if anyone has any experience with this and/or suggestions for a procedure code to capture this service as this is a high dollar product ($1,596)

We bill 510 rev G0463 for Medicare and some Medicaid (new policy) and 99213 for all other payers (which is usually adjusted off as they don't pay facility charges for office visits.)

Per UB04 editor is 636 is the only allowed rev code. If I try to bill this with just the 636 and J7336, I think we are just going to get it back as incidental due to no pass through charge edit.

Basic procedure
Requires use of topical anesthetic, correct application, pt monitoring for BP, comfort ie cold pack or analgesic medication.
Removal after 30 minutes for DM ulcer and 1 hour HPN by provider.


I was just wondering if anyone has any experience with this and/or suggestions for a procedure code to capture this service as this is a high dollar product ($1,596)
View attachment 5643
View attachment 5642

Click to expand...
I bill for Qutenza in an outpatient setting. I use 64632 (unilateral) or 64632-50 (bilateral). I bill the J7336 with the quanity of sq centimeters that was used. I also ad the JZ modifier to the J7336 in there was no waste in the med. These are all being paid by Medicare.
 
BMadren said:
I bill for Qutenza in an outpatient setting. I use 64632 (unilateral) or 64632-50 (bilateral). I bill the J7336 with the quanity of sq centimeters that was used. I also ad the JZ modifier to the J7336 in there was no waste in the med. These are all being paid by Medicare.
Click to expand...
We are just looking into providing this service. Can you tell me how many patches are typically used per foot? Looks like billing units are 280 per patch.
 
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