Are you sure they are using modifier 25 on the E/M code?
According to the CCI edits, the two codes are payable with a modifier.
Did they call Medicare?
I would appeal with records if Medicare is giving you a hard time. But it could be the billing staff?
And if they aren't paying the J3420 (which is a big .10 cents!!) I bet you it's because the diagnoses are incorrect. Here's my LCD for Trailblazer's ... I'm sure yours is the same or comparable ... it was revised again on 10/01/08. and if so, the denial would kick back 'not medically necessary'
Medicare is establishing the following dual diagnosis limited coverage for HCPCS code J3420:
As a reminder, J3420 administered for anemia in the treatment of cancer requires the most recent HCT and/or Hgb reading on the claim. This applies to claims received on or after April 7, 2008, with dates of service on or after January 1, 2008.
Covered for:
266.2*
Cyanocobalmin deficiency
281.0*–281.1*
Other deficiency anemias
Note: Codes 266.2* and 281.1* as the primary diagnosis requires a secondary (dual) diagnosis from the table below.
281.3*
Other specified megaloblastic anemias, not elsewhere classified (combined folate- B12 deficiency anemia)
Note: No secondary diagnosis is required for 281.0*, 281.3* or V58.11*.
V58.11*
Encounter for antineoplastic chemotherapy
Note: Use code V58.11* when administering vitamin B12 as a part of a regimen that includes pemetrexed (J9305).
The following are secondary (dual) diagnoses to be used with 266.2* and 281.1* (primary diagnosis) to meet limited coverage for HCPCS code J3420:
336.2
Subacute combined degeneration of spinal cord in diseases classified elsewhere
357.4
Polyneuropathy in diseases classified elsewhere
564.2
Postgastric surgery syndromes
579.0–579.2
Intestinal malabsorption
579.8
Other specified intestinal malabsorption
V45.3
Intestinal bypass status