Forum - Questions & Answers

Jan 14th, 2011 - mfreshour

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.

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Jan 15th, 2011 - ziaclarkson 30 

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.

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