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Trouble getting paid

  1. Default Trouble getting paid
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    I am having trouble getting paid for my J-codes that are being billed. How are these to be billed so they get paid? Sometimes the doctor is just billing an office visit with a J1642 and then sometimes they are billing it with other codes 96416 and an E0781?
    Please help

  2. #2
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    Columbia, MO
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    Can you elaborate on your scenario? An office visit only with heparin is not going to work so was this for a heparin flush? if so you cannot bill the office visit with the hep flush code. What about the chemo code, is this the initial chemo pump encounter?

    Debra A. Mitchell, MSPH, CPC-H

  3. Default details
    This is all on one patient, for multiple dates of service the doctor bills just 96523 and J1642 and neither are paying???? Then on some days she is billing just an office visit with a J1642???
    Finance Analyst

  4. #4
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    Columbia, MO
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    Now what dx code are using and what is the denial reason?

    Debra A. Mitchell, MSPH, CPC-H

  5. Default Example
    So some days she bills OV plus 96523 and J1642. The 96523 is not getting paid nor is the J-code.

    Second example: She bills the OV, J1260, 96365,J7050, A4212 and96360....
    Finance Analyst

  6. Default dx
    Dx is just 151.9. I am new to this coding so am I missing modifiers??? denial just says inclusive.
    Finance Analyst

  7. #7
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    Columbia, MO
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    Ok the flush code 96523 cannot be billed on the same day as anyother procedure or service and this includes the OV it will be considered inclusive.
    On the secon example.. several issues.
    **If this is chemo then you are using the wrong infusion code you wil need one for chemo infusion,
    **you cannot bill more than one initial service for the same encounter unless two veins were accessed.
    ** you cannot bill hydration uless documentation supports medical necessity (ie dehydration) and it must be documented as running for a minimum of 31 minutes as hydration with no other drug added.
    ** if for chemo then you must use a V58.1x dx code first listed
    ** for the port flush encounter you need a V 58.81 dx code
    ** you cannot code for an OV on the same day as chemo admin.

    Debra A. Mitchell, MSPH, CPC-H

  8. Default Is the J-code payable with flush
    So when billing the flush will i get paid for the 5FU drug as well?
    Finance Analyst

  9. Default Chemo infusion....
    So what are the chemo infusion codes i should use??
    Finance Analyst

  10. #10
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    Columbia, MO
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    You cannot bill a port flush on the same day as the 5FU admin. 5FU is chem and must be billed with a chemo admin code. Then no you cannot bill the heparin nor the port flush just the chemo admin and the 5 FU code, V58.11 is the dx code with the neoplasm secondary. Are you working for a physician office or an outpatient cancer center?

    Debra A. Mitchell, MSPH, CPC-H

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