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Denials Humana Help

  1. #1
    Default Denials Humana Help
    Medical Coding Books
    Hem/ONCo---denial states qualifying service/procedure needed

    codes

    96413
    96415
    96367
    96366
    j2469 9:20-10:40
    j2920 9:40- 10:00
    j2780 10:00-10:20
    J1453 10:40-11:15
    J9310 11:15-3:00

    cpt book states that 96413 and 96367 can be used together. Is anyone else getting this denail?
    Last edited by perkins05; 01-17-2012 at 11:23 AM.

  2. #2
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    Tacoma, WA
    Posts
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    Default
    Quote Originally Posted by perkins05 View Post
    Hem/ONCo---denial states qualifying service/procedure needed

    codes

    96413
    96415
    96367


    cpt book states that 96413 and 96367 can be used together. Is anyone else getting this denail?
    They can be used together, but the 96367 is supposed to be billed with 96365 first, for the first hour of the IV infusion for therapy, diagnosis or prophylaxis. Need to know what type of drug is being infused and why before we can really evaluate the denial.
    Arlene J. Smith, CPC, CPMA, CEMC, COBGC

  3. #3
    Default
    Thanks for responding Arlene.

    Drugs used

    j1200
    j2790
    j9310
    j2505

  4. #4
    Default
    Quote Originally Posted by perkins05 View Post
    Hem/ONCo---denial states qualifying service/procedure needed

    codes

    96413
    96415
    96367


    cpt book states that 96413 and 96367 can be used together. Is anyone else getting this denail?
    I don't see any reason you shouldn't be able to bill those CPT's - you could have the chemo as the primary procedure. Humana's kind of weird about making sure that the J-codes are on the same claim form as the admin codes, though - have you called them to get more information about the denial?

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