Wiki BCBS denying 11900, J3490

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aortega37

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Getting repeat denials from BCBS IL for 11900, J3490 with B07.0. The wart is not being destroyed, only injected with candida. It is a pediatric patient, unsure if that makes a difference. The denial reason code is "Missing/incomplete/invalid HCPCS"
Anyone got a hunch as to what's triggering the denial?
 
You might review whether J3590 is a better code than J3490; I believe this is a biologic, but I don't have experience with this procedure. Also, make sure you are including the candida antigen description and NDC since J3490 and J3590 are unlisted codes.
 
iowagirl77 said:
You might review whether J3590 is a better code than J3490; I believe this is a biologic, but I don't have experience with this procedure. Also, make sure you are including the candida antigen description and NDC since J3490 and J3590 are unlisted codes.
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We have been billing Candida with J3490 with the NDC and description and have had a hard time getting it paid via BCBS mainly, any suggestions on how to get it paid? Which NDC do you typically use for the Candida, I have seen several online but we are using the one on the bottle and it gets denied. Just trying to get any further info I can get! Thanks in advance for any advice you have! :)
 
Hi,
We do not charge for candida injections. But I can say that the NDC number needs to be the one on the box you are using and the billing digit format is usually 11 digits.
I know that some NDC's are lower than that and zeros need to be added.
 
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