Neurology & Pain Management Coding Alert

Question: Noridian is denying our claims for baclofen with J0475. Why is it suddenly doing this, and how should I be filing the claim?


Colorado Subscriber


Answer: Be sure to include modifier KD (Drug or biological infused through DME) when you submit claims for J0475 (Injection, baclofen, 10 mg).

Noridian updated its stance on J codes and cut back on its allowable diagnosis codes for baclofen. Acceptable first-line diagnoses now include 333.7 (Symptomatic torsion dystonia), 340 (Multiple sclerosis), 344.89 (Other specified paralytic syndrome) and 437.8 (Other ill-defined cerebrovascular disease). Noridian accepts 728.85 (Spasm of muscle) as a second-line diagnosis.

Because of policy updates, check with your local Noridian carrier to verify its current list of diagnoses supporting medical necessity. Clinical and coding expertise for You Be the Coder and Reader Questions  provided by Neil Busis, MD, chief of the division of neurology and director of the neurodiagnostic laboratory at the University of Pittsburgh Medical Center at Shadyside, and clinical associate professor in the department of neurology, University of Pittsburgh School of Medicine; and Laureen Jandroep, OTR, CPC, CCS-P, CPC-H, CCS, CodeRyte Inc. coding analyst and coding review teacher.