Forum - Questions & Answers
J codes- bilateral billing- with cortisone injections
when coding J codes, what modifier do i use to get this paid...i used a 50, it was kicked back for the modifier. also using lt and rt is not getting it paid either.
J code bilat
The problem with this procedure is that different payers like it differently presented. The -50 modifier goes not on the J code but on the procedure used to administer the drug. And some insurance companies don't want the -50.
Example: putting some depo medrol in a knee joint for knee pain:
20610-50 (injection in major joint, bilaterallly) 1 unit , price 150% of fee
J1040 (methylprednisolone) 2 units
This will get you paid from some payers including Medicare.
Others want to see it like this:
20610-RT , one unit, regular price
20610-LT, one unit, regular price
J1040 two units
some payers will prefer to reduce the services for the second procedure on their own
NO one I have seen ever wants to see
20610
J1040-RT
J1040-LT
That's just an example, I hope it helps.
The logic is : You are doing the procedure ... where/ bilaterally and using this supply while doing it.