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Trouble getting paid

R

Revenuecycle

Guru
Messages
167
Location
Plymouth, MA
I am having trouble getting paid for my J-codes that are being billed. How are these to be billed so they get paid? Sometimes the doctor is just billing an office visit with a J1642 and then sometimes they are billing it with other codes 96416 and an E0781?
Please help
 
Can you elaborate on your scenario? An office visit only with heparin is not going to work so was this for a heparin flush? if so you cannot bill the office visit with the hep flush code. What about the chemo code, is this the initial chemo pump encounter?
 
details

This is all on one patient, for multiple dates of service the doctor bills just 96523 and J1642 and neither are paying???? Then on some days she is billing just an office visit with a J1642???
 
Example

So some days she bills OV plus 96523 and J1642. The 96523 is not getting paid nor is the J-code.

Second example: She bills the OV, J1260, 96365,J7050, A4212 and96360....
 
Ok the flush code 96523 cannot be billed on the same day as anyother procedure or service and this includes the OV it will be considered inclusive.
On the secon example.. several issues.
**If this is chemo then you are using the wrong infusion code you wil need one for chemo infusion,
**you cannot bill more than one initial service for the same encounter unless two veins were accessed.
** you cannot bill hydration uless documentation supports medical necessity (ie dehydration) and it must be documented as running for a minimum of 31 minutes as hydration with no other drug added.
** if for chemo then you must use a V58.1x dx code first listed
** for the port flush encounter you need a V 58.81 dx code
** you cannot code for an OV on the same day as chemo admin.
 
You cannot bill a port flush on the same day as the 5FU admin. 5FU is chem and must be billed with a chemo admin code. Then no you cannot bill the heparin nor the port flush just the chemo admin and the 5 FU code, V58.11 is the dx code with the neoplasm secondary. Are you working for a physician office or an outpatient cancer center?
 
the payers usually default to the least paying line item which in this case is usually the ov. So yes you must drop the ov. When you have scheduled a patient to return for chemo admin then you cannot make a case for a separately identifiable office encounter. Even tho the provider does see the patient briefly prior to the administration the determination to give the chemo has already been made, on the occaision where the patient present too ill for the chemo then you may charge the ov but there will be no admin code.
 
One last thing

Do you have an email i could email you at with any future questions?

Also, one quick question....if billing a J1642 is this the code you say needs to be billed with the chemo. infusion codes????
 
J1642 is for the heparin, 5FU is a chemo drug.
if the purpose for the encounter is to insert the pump and start the chemo then use the pump inititation code with the drug, no office visit. I am fairly certain the pump code is inclusive with the intiation charge.
 
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