Billing for J-codes

We have had several denials from Medicaid regarding J-codes. The denial message says: INJECTIONS WHEN ALTERNATE DRUG OR ROUTE IS POSSIBLE REQUIRE MODIFIER. These claims are usually submitted with an office visit, so we do identify separate services with a 25 modifier. What other modifier would be needed?

Also, when billing decadron, rocephin etc., is the reimbursement different depending on the milligrams given?

Any assistance is greatly appreciated.

Thanks!

re: Billing for J-codes

State Medicaid programs don't follow CPT® rules. I think you have to call them about the error message. Who knows what modifier they want??

For medications, you need to look in the HCPCS book for the units of a drug.

Find the generic name:

decadron: dexamethasone

go to ICD9data.com (or your HCPCS book) and look at the drug, find the right drug that you are giving. Then, look at the dosage. The dosage is one unit. If you give 2 mg, then code for 2 units.

Betsy


2014 HCPCS J1094
Injection, dexamethasone acetate, 1 mg

J1100 Injection, dexamethasone sodium phosphate, 1mg