Urology Coding Alert

Question: We submitted a Medicare claim with 51715 for an endoscopic injection procedure along with five separate lines for the bulking agent (Macroplastique) at 1cc each using code L8606 (since 5cc were used). Medicare only paid one line item for L8606. The other four were denied (C097-Benefit for service included in payment/allowance for another service/procedure already adjudicated; N111-No appeal right except duplicate claim/service issue. Service included in claim previously billed/adjudicated). This is an expensive medication and we believe the physician should be compensated for product used. Should we have billed the L8606 differently? Is there a modifier that we could add?

Oregon Subscriber

Answer: According to CMS, “Contractors shall deny services for HCPCS with payment indicators L1 (Influenza vaccine; pneumococcal vaccine. Packaged item/service; no separate payment made), N1 (Packaged service/item; no separate payment made) or S1 (Service not surgical in nature; and not a radiology service payable under the OPPS, drug/biological, or brachytherapy source. Packaged item/service; no separate payment made).”

Your denial is because code L8606 has an ASC payment indicator of “N1,” which means this product is a packaged item, and payment may not be made separately for this product.