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Thread: J3301

  1. #1

    Default J3301

    AAPC: Back to School
    Does anyone have an accurate answer and supporting CMS web links to the proper guidelines of blling J3301? There were some previous discussions that I have reviewed in the orthopedic thread, but it still was not quite clarified. I am getting denials on this J code, but not the actual procedure code(s) 20600-20610.
    The denial explanation stated it needed a referring physician. My manager feels that it is something else beyond this. It really does not make sense that the procedure code and E/m code is being paid but not the J code, simply for a referring physician. Another issue that was raised was, is the J code bundled into the E/M code? The only thing so far I was able to find on the CMS Florida website is that effective May 2008, certain J codes including the J3301 will be denied w/o a valid NPI.
    Does anyone have any concrete supporting links?

  2. #2
    Join Date
    Apr 2007


    I believe that J3301 (Kenolog) bundles with the injection

  3. #3
    Join Date
    Apr 2007
    Capital Coders, Columbia, SC

    Default J3301

    All of my J3301's get paid (in South Carolina). The referring physician denial is odd, though. Sometimes, their denial reasons are a little mixed up (assuming we are talking about Medicare) such as the denial, "Claim lacks info" for a bad ID #. Is it just the J3301 you are having this problem with? You may want to make certain that you are sending the correct NDC #, qualifier and measure of units with it.

  4. #4
    Join Date
    Apr 2007
    Duluth, Minnesota


    The J3301 should be paid..who is the carrier (just curious)? The J3301 shouldn't be bundled in with the injection - you actually shouldn't be billing/coding and injection (90772) if there is an office visit or procedure with the J3301. The "injection" is bundled in with either the procedure performed (20605/20610 or whatever) or the office visit. Also, does the office visit have a modifier .25 on it? (it's needed due to the procedure being done), hopefully it supports and E/M with the procedure.
    in anycase, we get paid for J3301.
    well, that's my three pennies

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