Wiki RFL and J codes

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Woodlands, TX
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Can a physician bill separately for J3301 Kenalog and J1885 Toradol with RFL codes (64633, 64634, 64635, and 64636)?

Per CPT guidelines codes 64600-64681 include the injection of other therapeutic agents (e.g. corticosteroids.). Does it apply for administration only or for drugs as well?

The service performed at POS 11.
 
Yes we do bill J codes and did not have any issues with any insurance company, but one. Orthonet performed medical records review for Humana patient and recommended to deny J code as inclusive to RFL codes. The reason for denial is administration of corticosteroids is inclusive to RFL code per CPT code description.

Please advise what argument we should use to appeal.
 
I have not come across any J codes not being paid by Humana but we do not have a large patient population with Humana and I am not sure if RFL was done on any of them. I will keep an eye out.


Melissa Harris, CPC
The Albany and Saratoga Centers for Pain Management
 
CPT states: "Codes 64600-64681 include the injection of other therapeutic agents (e.g. corticosteroids.) ... For codes labeled as chemodenervation, the supply of chemodenervation agent is reported separately."

From this, it is clear that they are correct, the corticosteroid is not separately billable. The only thing you would be able to bill for separately is the agent used to destroy the nerve. Not sure, but I don't believe the toradol would fall into the category of destructive either.
 
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