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Thread: is J3490 billable with cpt 20550?

  1. #1

    Question is J3490 billable with cpt 20550?

    Is j3490 billable with cpt 20550 or is it bundled?
    It has a n1 asc payment indicator (packaged procedure/item; no separate payment made) in Hcpcs 2008
    Last edited by codecrazy; 12-09-2008 at 12:31 PM.

  2. #2
    Join Date
    Apr 2007
    Location
    Woodbridge, VA
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    103

    Default

    Both codes are billable together...there are no CCI edits.

  3. #3

    Smile

    So what is the n1 notation mean?

  4. #4
    Join Date
    Apr 2007
    Location
    North Carolina
    Posts
    3,127

  5. #5

    Default surgical package

    So if there is a surgery it is not payable. But if there was no surgery it can be billed?

  6. #6

    Default

    Who are you billing for? Physician? Hospital? Was this performed in-patient, outpatient, ASC, or office? When I coded for an office, I billed the drug. Now that I am coding for a hospital (professional services) I do not code the drug as that is billed by the facility coders.

    Amy

  7. #7

    Default

    Coding for the physician. Thanks

  8. #8
    Join Date
    Apr 2007
    Location
    orange, ca
    Posts
    179

    Default

    coding for the physician...it is billable, but may not be payable depending on the carrier...but you CAN bill the codes together since there are not CCI edits...N1 indicator means that Medicare wont pay for it.

  9. #9
    Join Date
    Apr 2007
    Location
    Honolulu
    Posts
    10

    Thumbs up Dont forget NDC # for J3490

    Dont think anyone has mentioned an important part of J3490 rules (apologize if I overlooked & am repeating)

    Injections have numerous rules per carrier so always be sure to check each carriers rules prior to billing but I am writing the basics from my exp. with billing J3490 and other J and S injection codes.

    J3490 is a "junk" code meaning it doesnt have a specific NDC#
    (which the NDC# is located on the packaging the bottle comes in

    Since these days most meds for injections have a specific HCPCS code, be sure to verify prior to billing that code:

    1. that there isnt a specific J code you should be using instead of J3490
    2. if you locate a HCPCS J code, then also verify total cc/ml/mg per unit , so you dont overbill (ex. code shows 20 mg/cc or ml in description, documentation show 40cc given, then you would bill 2 units)
    3. Look up the J or S code (online if you dont have a new HCPCS book) and verify the NDC#'s you have match the NDC# for that code because some J codes have more than 1 to select from dep. on concentration of medicine.
    4. J and S codes change so verify the code is still valid & ensure if you locate a J or S code via searching the internet that the code is still valid via a new HCPCS book.

    (20mg, 40mg & 60mg are ex. of the diff. in regards to the same name of 1 med. but if 20cc/mg/ml it may show as J1020, then a 40mg would show as J1030 and a 40mg. would have a HCPCS J code of J1040 & each of those J codes have different NDC's as a way to defientely know you have the right HCPC's code to bill)

    Billing TIP:
    If sending paper claims, (or if you use Medisoft)you can either:
    Add the NDC# to the Local Use B field (Box 19 on the CMS form)

    I use Medisoft, so I enter it either the NDC# in the patient's case on the Miscellanous tab. (local Use B field).

    Most carriers will allow you to write the NDC number in Local Use B field or right above the J3490 line. So check your carriers rules to ensure accuracy.

    if no J or S code is specific to medication you are giving then yes use the J3490 code:

    If J3490 is the code then be sure to write total #of cc/mg or ml given to the patient per documentation as the units (J3490 is per 1cc/mg or ml per unit).


    Would love other billers/coders to give their experiences with injections and any tips they have to coding/billing J or S codes correctly the first time!

  10. #10

    Smile Thank you

    2017 ICD-10-CM Coding Book
    Thank you for all your help. It is appreciated.

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