Forum - Questions & Answers

Aug 17th, 2011 - precod 10 

Promed Denial for CPT® J1040,S0020, J2001

We are Coding for the Office Visit, Promed Insurance is denying CPT's J1040,S0020 and J2001 stating bundled with CPT® 20610. Pls guide how to carry on with this denial

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Aug 17th, 2011 - DebraS   67 

re: Promed Denial for CPT® J1040,S0020, J2001

First of all, what does your contract with this carrier say about this procedure? We have contracts where we cannot bill ABC out to a particular carrier, but we can with other carriers.

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Aug 26th, 2011 - precod 10 

re: Promed Denial for CPT® J1040,S0020, J2001

My carrier says it is bundled with E/M. I will not pay for J1040,S0020,J2001.

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Aug 18th, 2011 - jschmutz   323 

re: Promed Denial for CPT® J1040,S0020, J2001

You should not be reporting S0020 and J2001 with 20610, it is bundled because the CPT® and CMS surgical global package for ALL procedures (even injections) include local infiltration, digital blocks and topical anesthesia (lidocaine) and cannot be separately reported. In addition, J2001 is an INTRAVENOUS injection for INFUSION which is not what you are doing. You are coding this incorrectly, and if you have been getting paid for this in the past then I suggest you do something about it because if the payers find out they will come back for their money and hopefully that is all. You wouldn't want to be prosecuted.

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Aug 26th, 2011 - precod 10 

re: Promed Denial for CPT® J1040,S0020, J2001

So as per the reply we need to report 20610 only. please coorect me if am wrong

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