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Infusion + shots

  1. #1
    Location
    Greenville, NC
    Posts
    91
    Default Infusion + shots
    Clearnace Sale
    We have pt that comes in regularly for Xolair injections and we bill and are paid billing it as follows:

    96372-RT
    96372-LT
    96372-RT/59

    This pt recently came in for Reclast infusion on same date as Xolair injections. We billed as follows:

    J3489 - paid by BCBS
    96365 - paid by BCBS
    96372-RT - DENIED
    96372-LT - DENIED
    96372-RT/59 - paid by BCBS

    The denial on the two 96372's denied was CO-97 - This service/procedure is included in a service already paid.

    Can anyone tell me how to get the entire claim paid?

    Thanks for any assistance you can provide!

    Hunter Smith, CPC

  2. #2
    Default
    96372 bundles to 96365 under NCCI rules (my guess is that's probably to prevent billing of an injection of lidocaine given as part of the IV placement, which would be incidental). You will probably need the 59 (or XU or XS) modifier on the other two injections in order to separate them from the infusion on the same date to get proper payment for those.

  3. Question Infusion + Mue +Modifier
    Good Afternoon,

    Previously we have received denials from medicare denying Codes J9047 due to # of services not supported. Claim were billed as listed below:

    96375 PO 1 UNIT = PAID
    80053 PO 1 UNIT= BUNDLED
    82784 PO 3 UNIT = BUNDLED
    83883 PO 2 UNIT = BUNDLED
    82232 PO 1 UNIT = BUNDLED
    86334 PO 1 UNIT = BUNDLED
    85025 PO 1 UNIT = BUNDLED
    96413 PO 1 UNIT =PAID
    J1100 PO 8 UNIT = BUNDLED
    J7050 PO 1 UNIT = BUNDLED
    J9047 JG JW PO 40 UNITS= DENIED
    J9047 JG PO 140 UNITS= DENIED

    Can someone help me with getting this paid, would I be able to use modifier 59 on the wastage line ???
    thank you for you help.

  4. Question Infusion + Mue +Modifier
    Quote Originally Posted by thomas7331 View Post
    96372 bundles to 96365 under NCCI rules (my guess is that's probably to prevent billing of an injection of lidocaine given as part of the IV placement, which would be incidental). You will probably need the 59 (or XU or XS) modifier on the other two injections in order to separate them from the infusion on the same date to get proper payment for those.
    Good Afternoon Thomas 7331,

    Previously we have received denials from medicare denying Codes J9047 due to # of services not supported. Claim were billed as listed below:

    96375 PO 1 UNIT = PAID
    80053 PO 1 UNIT= BUNDLED
    82784 PO 3 UNIT = BUNDLED
    83883 PO 2 UNIT = BUNDLED
    82232 PO 1 UNIT = BUNDLED
    86334 PO 1 UNIT = BUNDLED
    85025 PO 1 UNIT = BUNDLED
    96413 PO 1 UNIT =PAID
    J1100 PO 8 UNIT = BUNDLED
    J7050 PO 1 UNIT = BUNDLED
    J9047 JG JW PO 40 UNITS= DENIED
    J9047 JG PO 140 UNITS= DENIED

    Can someone help me with getting this paid, would I be able to use modifier 59 on the wastage line ???
    thank you for you help.

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