# Billing medicare for pump refill medications



## fvella (Jun 4, 2010)

We are getting denials from Medicare for reimbursement of pump refill medications. What is the correct way to code for BUPIV SO4 Morphine Sulfate
2.5/25mg? I would really appreciate help with this. Also some of our patient's receive just Morphine. I am new to Pain Management Coding and need help with this. We have even appealed one of the claims including all the documentation, but they still denied it. I have been using the J3490 code and writing in the prescription to go with the claim.


----------



## cmcgarry (Jun 4, 2010)

fvella said:


> We are getting denials from Medicare for reimbursement of pump refill medications. What is the correct way to code for BUPIV SO4 Morphine Sulfate
> 2.5/25mg? I would really appreciate help with this. Also some of our patient's receive just Morphine. I am new to Pain Management Coding and need help with this. We have even appealed one of the claims including all the documentation, but they still denied it. I have been using the J3490 code and writing in the prescription to go with the claim.



Who is your Medicare carrier?  I have the guidelines from WPS and Noridian on how they want the compounded pump refills billed to them - so if one of those is your carrier, I can send you the information.  Both of them published the information in their newsletters, so if they're not yours, you could search your carrier's newsletters for the information.


----------



## dwaldman (Jun 4, 2010)

http://www.customcoder.net/reader/article_print/212812

Found this on the internet. WPS instructions that were mentioned in the other post you received.


----------



## fvella (Jun 7, 2010)

Thank you so much. I went to the website and printed out the information. I think what I have been missing is the KD modifier and telling them the the Documentation is Available on Request. I wonder if it would be less time consuming to just print the claim to paper and send it manually along with the documentation? Thanks again. 
Fae


----------



## fvella (Jun 7, 2010)

Thank you for the reply. Our carrier is Pa Blue Shield of Western Pennsylvania. I did look up the information from WPS from CustomCoder.net and will try using the KD modifier and including the "route of administration". The other information I was already providing and I was using the J3490 code.


----------



## marvelh (Jun 7, 2010)

Are you talking about Medicare processing pump refills or a commercial Blue Cross insurance?


----------



## FCORBIN2 (Jun 24, 2010)

*Pain pump meds to medicare*

We are billing our combination meds with J3490KD, and they are denying electronically by Medicare, so i get a payer report back stating they need a more specific procedure code. How can i fix this so we can get paid? 
HELP PLEASE.


----------

