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LCD Guidelines for J3420 -- UNITS

  1. #1
    Exclamation LCD Guidelines for J3420 -- UNITS
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    I am having a lot of problems lately getting J3420 paid. Here's how we'll bill it:

    J3420 x2 units

    Medicare keeps giving us a rejection of CO151. I finally got some info out of a Medicare rep that it has to do with the Units billed. I noticed that when we bill J3420 x1 unit.. it gets paid. We're billing the correct DX code too. I checked LCD for that. 281.0. BUT, the LCD doesn't give me anymore information than that on really how many units the pt can receive. I've read on a coding site one time say limit is once per month...I get that...need info on the UNITS.

    CAN SOMEONE PLEASE HELP ME WITH THIS? If anyone has a link to anything that can tell me Units that is allowed and so forth. I know we can get this paid. Just want to know how! Furthermore, if we can only bill for 1 unit. I need the info to share with our physicians.



    Sarah, CPC

  2. #2
    New York State Capital District Professional Coders, Albany, NY
    The J3420 code in HCPCS says 'up to 1000 mcg'. How much is the patient being given? I think you might find in the majority of the cases that you do not go over 1000 mcg. Therefore 1 unit should be sufficient. Does this make sense?

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