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20553 with multiple units of J1040

  1. Default 20553 with multiple units of J1040
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    I do the billing for an office who is having difficulty getting their J1040 paid. They are billing 20553 with an insurance note letting them know which muscle groups were injected and then J1040 x 4. The 20553 is allowed but the J1040 is denied for quanity. They are injecting 4 muscle groups bilaterally, 40mg per injection, which equals 4 units. Does anyone know why Medicare is denying the J1040 x4, and how this should be billed to get it paid? Any advice is appreciated. Thank you!

  2. #2
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    Might require a call to customer service, they might be able to provide additional reasoning to the denial code.

  3. #3
    Location
    Sioux Falls, SD
    Posts
    15
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    J1040 is for 80 mgs, J1030 is 40 mgs

  4. #4
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    http://questions.cms.hhs.gov/app/ans...tCZDVvaw%3D%3D


    How do I report medically reasonable and necessary units of service in excess of a Medically Unlikely Edit (MUE) value?

    Published 11/06/2007 01:30 PM | Updated 03/01/2011 04:19 PM | Answer ID 8736

    How do I report medically reasonable and necessary units of service in excess of a Medically Unlikely Edit (MUE) value?



    Since each line of a claim is adjudicated separately against the MUE value for the code on that line, the appropriate use of Current Procedural Terminology (CPT) modifiers to report the same code on separate lines of a claim will enable a provider/supplier to report medically reasonable and necessary units of service in excess of an MUE value. CPT modifiers such as -76 (repeat procedure by same physician), -77 (repeat procedure by another physician), anatomic modifiers (e.g., RT, LT, F1, F2), -91 (repeat clinical diagnostic laboratory test), and -59 (distinct procedural service) will accomplish this purpose. Modifier -59 should be utilized only if no other modifier describes the service.


    AHA Coding Clinic Second Quarter 2009

    How do we bill Depomedrol 120mg since HCPCS codes J1020-J1040 are mg specific? Also, if injecting Depomedrol 80mg (J1040) in both knees, how should this be reported?

    Answer:

    According to guidance provided by CMS for hospitals under the OPPS, hospitals now have the option to report multiple HCPCS codes for a single drug administered, or continue to bill the HCPCS code with the lowest dosage descriptor available. Therefore, your reporting options are: 1 unit of HCPCS code J1040, Injection, methylprednisolone acetate, 80mg, and 1 unit of HCPCS code J1030, Injection, methylprednisolone acetate, 40mg, Or 3 units of HCPCS code J1020, Injection, methylprednisolone acetate, 20mg, for the injection of 120mg of Depomedrol, Or 6 units of HCPCS code J1020, Injection, methylprednisolone acetate, 20mg, for the injection of 120mg of Depomedrol.

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