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J-code and modifiers

  1. #1
    Location
    Stratford, NJ
    Posts
    39
    Default J-code and modifiers
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    My office has noticed we're getting claim rejections on a lot of our botox injections. We are pain management so these are not for cosmetic purposes. We bill a 6461x for the chemodenervation w/a RT or LT mod then the add-on code 95874 for the needle guidance, also w/a RT or LT mod. We do not add a mod to the J7323 code for the botox. Our business office is being told the modifier is required on the J-code and has always been required, but I'm sure we did not use a mod before.

    Any insight??

  2. #2
    Default
    I work for an ortho. We always add lt/rt to our j codes....otherwise they deny

  3. #3
    Location
    Stratford, NJ
    Posts
    39
    Default
    thanks mswalker!! I'm glad to have the confirmation!

  4. #4
    Location
    North Carolina
    Posts
    3,126
    Default
    J7323 (Hyaluronan) is typically administered for osteoarthritis. The correct code for Botox is J0585/J0587. This link may be helpful.

    http://www.aan.com/news/?event=read&article_id=4746

  5. #5
    Location
    Duluth, Minnesota
    Posts
    1,133
    Default
    I've never used a rt/lt on Jcodes....hmmm...
    Donna, CPC, CPC-H

  6. Default
    Wow! I would have never even thought to add a LT/RT modifier to a J-code! I know insurance companies make no sense sometimes, but how could a medication have a paired organ?! LOL

    We have seen denials lately for J codes, but only in reference to NDC codes. That's a whole 'nother ball of wax.

  7. #7
    Default J-code and modifiers
    Hi. I work in a large billing department and I have been assigned Pain Management as my area. I have seen that they bill the 64614 more than once (the difference being they add a -76 modifier to the second occurrance) along with modifiers RT/LT. I am looking on clarification on this. From what I have read (so far) I thought this code could only be billed once per procedure. And how should an injection in multiple sites be billed (once with multiple units)? Thanks.

  8. #8
    Location
    Stratford, NJ
    Posts
    39
    Default
    to Mstroman:
    You should only be billing the 64614 one time for any injections to the extremities or trunk muscles. If the dr did injection on rt arm and another on the neck, then you would bill the 64614 for the arm, and then a 64613 for the neck. No -76 mod. If he did 2 injects in the arm, you still only bill the 64614 once. (look at description of the main code...64612 which says "chemodenervation of muscle(s)." If 2 different muscles in the arm done...bill 64614 only once.

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