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Injections/ J-Codes

  1. Default Injections/ J-Codes
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    Are Modifiers -RT and -LT required on all J-Codes? We are getting many rejections for this regarding especially SYNVISC. I thought that the modifier -rt or lt was stated in the procedure only....

  2. Default
    LT or RT should go on the procedure only. I looked up the synvisc code in encoderpro and there are no modifiers approved for this code. If you have a particular carrier that is rejecting these for not having modifiers on them, I would take it up with that carrier individually as some have their own requirments.

  3. #3
    Location
    Nassau Central New York
    Posts
    10
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    The Rt/Lt modifiers must also be put on the drug codes. If you are billing synvisic,supartz,orthovsic not only do the RT/LT modifiers must be applied but an EJ modifer as well if this is the 2nd,3rd,4th etc... injection. This is policy in New York (downstate). You can find information on the insurance carriers website that you are billing for under their policies.
    dede

  4. #4
    Location
    Greeley, Colorado
    Posts
    2,045
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    I don't use rt/lt on J codes for joint injections, just use units on one line item and have no issue getting paid for the units.
    Lisa Bledsoe, CPC, CPMA

  5. #5
    Location
    North Carolina
    Posts
    3,126
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    Typically, we don't add RT/LT to our J code; however, Synvisc One does have this requirement...or so we're told. We're still researching the billing guidelines for this medication since we're in the process of administering it. So far, the carriers (for our locality) are requiring these modifiers.

    http://www.synviscone.com/HCP/reimbursement/codes.aspx

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