Wiki Admin code Denied due to Descriptor of "injection"

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ccosta

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Okay folks this is a new one on me.
I have been informed that one would not pay the administration code for any J code that has the word "injection" as descriptor, since it is supposed to mean the cost of the injection is incorporated into the price of the code.
Now before you shake your head in disbelief, remember it does state Injection in the descriptor on a majority of the J codes. I was taught this was used to distinguish between drugs that can be taken orally and those that are injected. So now I need to find the verbiage to counter act that rational, even the CCI edits were not recognized, only descriptor and scrubber in place.
Any assistance on this would be grateful.

Thank you
 
Injections

You are right - as noted by the title of the "J" section: Drugs Administered Other Than Oral Method. CMS distinguishes between the drug and method of administration. Your answers will be found in the CMS Medicare Claims Processing Manual. An example of coverage of administration is found at https://www.cms.gov/Medicare/Prevention/Immunizations/Providerresources.html.

Under "Billing" for immunizations it states repeatedly: "Two procedure codes need to be on a claim for Medicare reimbursement for each type of vaccination. One code is for cost of the vaccine itself, and the other code is for the cost of the administration of the vaccine."
 
Is it a commercial payer? My only guess is they are changing their payment policies and no longer paying separately for the process of injecting drugs.
 
well they follow CMS but do commercial as well. it is not immunization codes mostly drugs, so would the verbiage for immunizations follow suit for drugs?
thanks
 
We too are having the same issue. Commercial insurance not paying any admin code if billed with any OV. Per Clear Claim Connection if we where to up-code the OV they would pay the admin. BUT have found that to be untrue as well when we actually do have to up-code they still do not pay the injection or vaccine admin.
 
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