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Thread: J3301 Kenalog Denied

  1. #1

    Default J3301 Kenalog Denied

    Medicare is denying the kenalog code J3301, which I am billing with the NDC # and
    dosage. My AR person is telling me Medicare is denying for "wrong description" of
    code. I have not seen the EOB, but any ideas on the denial as wrong description.

    Thanks,

    Cw

  2. #2
    Join Date
    Apr 2007
    Posts
    40

    Default

    All unlisted/not otherwise specified codes must have a desription in edit line note on the claim. So for example, for J3301 we put "triamcinolone acetonide 10mg" in the edit line note.

  3. #3

    Default J3301

    I am having the same difficulty. After several phone calls with Trailblazer Health (J4 Medicare Contractor), it boils down to needing that description in Loop 2300 or 2400, Segment NTE01 and NTE02. Now my software vendor is looking into it, because whatever they are sending is not following the crosswalk to those Loops and segments. We have tried placing it everywhere we can think of in the claim entry.

    As a side note, if you look up the "Part B Ask-the-Contractor Teleconference
    Questions and Answers,June 13, 2012" You get this!
    Question:
    We are having trouble with injection charges, primarily B12 (J3420) and Kenalog® (J3301). I understand B12 is a non-covered benefit, but I thought Kenalog® was covered. Also, what is the proper way to charge for these services with administrative fees, nurse’s visit, etc?
    Answer:
    Vitamin B12 (J3420) and Kenalog® (J3301) are non-covered by Medicare. The administration fee is non-covered if the drug is non-covered.

    !!! I called Medicare and was told that it was covered, so who really knows the answer to this????

  4. #4
    Join Date
    Apr 2007
    Location
    Columbia, MO
    Posts
    11,897

    Default

    They are covered based on the diagnosis and number of times injected and how far apart they are injected. Also you cannot charge an office level to administer an injection such as a 99211.

    Debra A. Mitchell, MSPH, CPC-H

  5. #5

    Smile J3301 Kenalog

    In our facility we use ECW software and how we enter it in order for our clearing house not to rejected it is as follows:

    1. Reports
    2. Reports Console
    3. Under Billing click on Additional claim data/options
    4. Enter claim #
    5. Hilite the line that has the J3301
    6. click on update ( should be on the right)
    7. hilite description, copy, and paste on the window below, ok.

  6. #6
    Join Date
    Apr 2007
    Location
    Everett, WA
    Posts
    880

    Default

    I've been dealing with similar issues, only have come to find out that it involved an updated NDC code and our software did not reflect the new changes. Don't know if this would apply to your situation, but was furnished the correct NDC number, updated the system, and now the line item J codes are once again being processed and paid.
    Suzanne E. Byrum CPC
    Noridian
    NGS

  7. #7

    Default J3301

    If the physician documents:
    used 6 cc of 4 mg kenalog.
    How can we bill the code?

  8. #8

    Default

    Quote Originally Posted by cwilson3333 View Post
    Medicare is denying the kenalog code J3301, which I am billing with the NDC # and
    dosage. My AR person is telling me Medicare is denying for "wrong description" of
    code. I have not seen the EOB, but any ideas on the denial as wrong description.

    Thanks,

    Cw
    I have a similar problem with J3301, but only when billing Medicare. Our workaround is just to wait until the claim rejects via the clearinghouse, then edit the claim manually and put in the correct descriptor, and then re-send electronically

  9. #9

    Default

    Quote Originally Posted by lucyf1122 View Post
    If the physician documents:
    used 6 cc of 4 mg kenalog.
    How can we bill the code?
    Try putting the descriptor in block 19 of the HCFA. We found out our billing software wasn't transmitting it on the file. When that is fixed, at least all the information will be at the payor.

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