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J3301 Rejection - I have a claim that is being rejected

  1. Default J3301 Rejection - I have a claim that is being rejected
    Medical Coding Books
    I have a claim that is being rejected by Medicare stating J3301 is "rejected for relational field in erro, check detailed description of service". What does this mean?

    It is being billed with a 99214-25,20610-LT, and 73030-TC. Any ideas???

  2. #2
    Location
    Greater Orlando
    Posts
    146
    Default TC?
    Are you sure about the TC modifier on your Radiologic examination, shoulder; complete, minimum of 2 views? I was expecting to see a 26, Professional Component, not a TC, Technical Component.
    Ron McKenzie, CPC-A
    Greater Orlando FL Chapter

  3. Default
    Yes, we're billing the technical component of this. I don't think this would have any impact on the J3301.

  4. #4
    Location
    Greater Orlando
    Posts
    146
    Default
    Okay, who is billing the professional component? If your doc owns the radiologic equipment, wouldn't you bill the procedure with no modifier(s)? Or is someone else (different NPI) doing the interpretation and report? Or is the professional component considered to be part of the E/M? (I'm new so this is all going towards educating me.)

    Might their challenge with the RT modifier? Using it shouldn't make any difference but might it be tripping up the edit?
    Last edited by RonMcK3; 01-03-2012 at 07:15 PM.
    Ron McKenzie, CPC-A
    Greater Orlando FL Chapter

  5. #5
    Location
    Columbia, MO
    Posts
    12,965
    Default
    Quote Originally Posted by aklunder View Post
    I have a claim that is being rejected by Medicare stating J3301 is "rejected for relational field in erro, check detailed description of service". What does this mean?

    It is being billed with a 99214-25,20610-LT, and 73030-TC. Any ideas???
    Did you include the NDC number on the claim?

    Debra A. Mitchell, MSPH, CPC-H

  6. #6
    Default
    Please be advised that your practice may now see claims in hold with the following claim note: “CMS is requiring a description of services provided for all CPT lines where the procedure code is a not otherwise specified code. Please review these claims for any CPT lines where the procedure code description in CodeCorrect contains text such as "Not otherwise specified" or "Not otherwise classified." For all such lines, please add a line note describing the unlisted procedure code and resubmit the claim.

    https://www.cms.gov/ElectronicBillin...FFSEditing.asp

    You will need to put a description in the edit box on the claim. example - Kenalog 10 mg
    Last edited by RHardy; 01-19-2012 at 02:43 PM. Reason: adding info

  7. #7
    Default
    I believe it is a 5010 edit. I would contact either Medicare or maybe your clearing house to see if they can give you info on how to get it corrected
    Herbie W Lorona Jr., CPC, CPC-H
    hlorona@up2parmedicalclinic.com

  8. Default
    First, when billing an any x-ray for a SNF patient you need to apply to -26 modifier to the procedure code and ONLY if your office pays your x-ray technician and owns the equipment, can should you bill the -TC modifier with the procedure code directly to the SNF.

    Regarding the denial for the J3301, it also sounds to me that this denial may be tied to the 5010 edits. We too are having trouble with our claims getting to Medicare, but this is due to our software not being 5010 compliant. Good news is our update is coming next week!

    I would double check with your Clearinghouse to see what rejection they are receiving on their end. They should definitely be able to tell you!

    Hope this helps!

    ** I also posted a question yesterday regarding "New Patient Consults" would love to have to look for that and what your opinion is! **

  9. #9
    Location
    Fort Smith, AR
    Posts
    42
    Default
    We are also getting the same rejections. Could anyone else tell me what they add in the NOC description? For example with J3301, we have "Kenalog" as the description but I'm wondering if they need more... Should we add "Kenalog-40 80mg" instead? or? Any help is appreciated.

  10. Default
    We are experiencing the same issue with J3301. I've already resubmitted with the NDC and am still getting a rejection. If anyone gets to the bottom of this, it would be helpful to hear what you find out.

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