Wiki Sequencing of 96402 and J9217

[alp.jeffrey]

Just checking to see what you all say. I have always sequenced 96402 followed by J9217. My coworker says the opposite because of the charge amount of the J code. So, which is it?

 

[sls314]

Just checking to see what you all say. I have always sequenced 96402 followed by J9217. My coworker says the opposite because of the charge amount of the J code. So, which is it?

In my experience, the thought process of sorting claim lines by charges comes from wanting to have the highest RVU items listed first. That's the old school way of doing it from when insurers needed the claims in RVU order to process claims correctly. (I still do it out of habit, even though most insurer's don't really need it that way anymore as claims processing technology has shifted.)

J codes have no RVU value, so the RVU sequencing wouldn't have been applicable in the case of 96402 with a J code anyhow.

We sequence the administration/injection codes first, followed by the J code. The administration code tells what the provider did, and the J code tells what the drug was.

(Whether or not that sequence affects the claim processing, I'm honestly not sure. I've never tried it the other way around. My gut instinct is that it probably doesn't because the payer's system is going to look for a match between the admin and J code anyhow, but stranger things have happened.)

 

[alp.jeffrey]

In my experience, the thought process of sorting claim lines by charges comes from wanting to have the highest RVU items listed first. That's the old school way of doing it from when insurers needed the claims in RVU order to process claims correctly. (I still do it out of habit, even though most insurer's don't really need it that way anymore as claims processing technology has shifted.)

J codes have no RVU value, so the RVU sequencing wouldn't have been applicable in the case of 96402 with a J code anyhow.

We sequence the administration/injection codes first, followed by the J code. The administration code tells what the provider did, and the J code tells what the drug was.

(Whether or not that sequence affects the claim processing, I'm honestly not sure. I've never tried it the other way around. My gut instinct is that it probably doesn't because the payer's system is going to look for a match between the admin and J code anyhow, but stranger things have happened.)

Thanks Susan. I'm not sure if it processes differently. I may look into that just for my own curiosity.

 

[CBLENNIE]

We sequence the administration/injection codes first, followed by the J code. The administration code tells what the provider did, and the J code tells what the drug was.

(Whether or not that sequence affects the claim processing, I'm honestly not sure. I've never tried it the other way around. My gut instinct is that it probably doesn't because the payer's system is going to look for a match between the admin and J code anyhow, but stranger things have happened.)

I work for an insurance company and for our claims adjudication system it doesn't matter which order the codes are in on the claim. I will say that the majority of claims we receive do list all of the CPT admin codes followed by the HCPCS codes for the drug(s). The only thing that does matter in sequencing of the HCPCS codes is when you are billing for drugs dispensed from a single use vial, we want the line for the amount of the drug administered listed before the line with the code with modifier JW/JZ on the line after the line for the administered line. If there are multiple single use vial drugs being administered, we want to see the codes grouped together for the administered and JW/JZ lines, for example:

• J1234 20 units $100.00
• J1234-JZ units 0 $0.00
• J5678 10 units $200.00
• J5678-JW 5 units $100.00

Hopefully the example makes sense.