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Billing medicare for pump refill medications

  1. Default Billing medicare for pump refill medications
    Medical Coding Books
    We are getting denials from Medicare for reimbursement of pump refill medications. What is the correct way to code for BUPIV SO4 Morphine Sulfate
    2.5/25mg? I would really appreciate help with this. Also some of our patient's receive just Morphine. I am new to Pain Management Coding and need help with this. We have even appealed one of the claims including all the documentation, but they still denied it. I have been using the J3490 code and writing in the prescription to go with the claim.

  2. #2
    Location
    Sioux Falls South Dakota
    Posts
    358
    Default
    Quote Originally Posted by fvella View Post
    We are getting denials from Medicare for reimbursement of pump refill medications. What is the correct way to code for BUPIV SO4 Morphine Sulfate
    2.5/25mg? I would really appreciate help with this. Also some of our patient's receive just Morphine. I am new to Pain Management Coding and need help with this. We have even appealed one of the claims including all the documentation, but they still denied it. I have been using the J3490 code and writing in the prescription to go with the claim.
    Who is your Medicare carrier? I have the guidelines from WPS and Noridian on how they want the compounded pump refills billed to them - so if one of those is your carrier, I can send you the information. Both of them published the information in their newsletters, so if they're not yours, you could search your carrier's newsletters for the information.
    Lucinda (Cindy) McGarry, CPC-P
    Applications Specialist
    Avera Health Plans
    Education Office Sioux Falls SD Local Chapter
    Past President Sioux Falls SD Local Chapter

  3. #3
    Default
    http://www.customcoder.net/reader/article_print/212812

    Found this on the internet. WPS instructions that were mentioned in the other post you received.

  4. Default
    Thank you so much. I went to the website and printed out the information. I think what I have been missing is the KD modifier and telling them the the Documentation is Available on Request. I wonder if it would be less time consuming to just print the claim to paper and send it manually along with the documentation? Thanks again.
    Fae

  5. Default
    Thank you for the reply. Our carrier is Pa Blue Shield of Western Pennsylvania. I did look up the information from WPS from CustomCoder.net and will try using the KD modifier and including the "route of administration". The other information I was already providing and I was using the J3490 code.

  6. #6
    Location
    Denver Colorado
    Posts
    279
    Default
    Are you talking about Medicare processing pump refills or a commercial Blue Cross insurance?

  7. Default Pain pump meds to medicare
    We are billing our combination meds with J3490KD, and they are denying electronically by Medicare, so i get a payer report back stating they need a more specific procedure code. How can i fix this so we can get paid?
    HELP PLEASE.

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