Administration of J Code

What would be the appropriate admin code for J2930, J3420 subQ injections in office? I had been using 96372 with modifier 76, but now it is not being accepted.

Can you give me some info on this issue?

Thank you very much.

Karen

re: Administration of J Code

Modifier -76 is inaccurate. Diagnosis must establish medical necessity (especially for B12) IM injection. Did you try 2 units of 96372? Check the denial message. Each payer has their own policies on administration codes.

re: Administration of J Code

We are assuming that the 2 units are J2930, J3420 Should the dx for j3420 be 281 (pernicious anemia or 780.79 excessive daytime tiredness) for J3420 deeming 96372 allowable?

thank you

re: Administration of J Code

I think it's best if you just list the codes and the diagnosis you used when you filed the claim. It is difficult to give you an answer without all the information. Pernicious anemia will be paid for J 3420 but I have to see exactly how these codes were Billed.

re: Administration of J Code

When you have 2 different drugs like in your question you have the right to code 96372 twice, but the 2nd has to have 59 modifier. The reason 76 is wrong is because your drugs are different. Also know that CPT® 96372 is not billable with units.

re: Administration of J Code

Ok this is what we would bill:

99214 25 490.93, 780.79
94060 59 493.90
94664 59 493.90
J2930 493.90
J3420 780.79
96372 (2 units)

Can you please advise? Thank you!

re: Administration of J Code

The diagnosis you listed for B12 injection is not covered by Medicare.
CPT® codes 96372 and 96374 are bundled with many other procedures, including electroconvulsive therapy, biofeedback, some CPT® codes for dialysis management, esophageal studies, some ophthalmologic studies, some diagnostic pulmonary procedures including spirometry, and many cardiovascular procedures including electrophysiologic studies, cardiac stress tests, and echography and diagnostic cardiology studies. Note that this is not an inclusive list.
Check with payer for specific guidance. What did the denial say.

re: Administration of J Code

ok this is the response I get for it:
236 This procedure or procedure/modifier combination is not compatible with another procedure or procedure/modifier combination provided on the same day according to the National Correct Coding Initiative or workers compensation state regulations/ fee schedule requirements.

Should I reduce it to one unit just for J2930 ? and should i put a 59 modifier along with it?