Wiki Depo Injection - Hope someone can help

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kavon57

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Hope someone can help. Up until implementation of ICD-10 we billed a depo shot with dx code V25.40 and cpt J1050 and 96372 with no issues and payment in full. Now we bill Z30.42 with the same CPT's and Horizon New Jersey won't pay on the admin code. They say it's the wrong code to use with the dx.

I know the dx code is right but I can't seem to find the correct admin fee code to use for the injection of the depo. Has anyone else come across this problem and were you able to resolve it?

Thanks!
 
In my facility, we bill it out exactly as you do. Pay close attention to the units of Depo. In my facility, they are all 150mg, so we bill out the J1050(1mg) x150. That was the only thing I did not see in your note above. Are they giving a reason as to why it is the wrong code?

I hope this helps!
 
The denial is 'This diagnosis and procedure combination is not considered a part of the family planning benefit'. And the denial is for the 96372, they're paying the 150 units of J1050.

So far the only one who has come to me is the HNJH biller so it could be some kind of a glitch. Although when she called they told her the same thing. The problem is that we do ALOT of depo shots.

Is the 96372 paying on your claims?
 
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