Wiki J1644 and 96365

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ashley.roberts@nchmd.org

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Hello all! We are a multi specialty practice and our infusion office is having issues getting J1644 (Heparin) to pay along with 96365 (IV Infusion). We use Encoder Pro for CCI edits and according to Encoder Pro, 96365 is the primary code and we have a choice of these modifiers:

59 Distinct Procedural Service
PD Diagnostic or related nondiagnostic item or service provided in a wholly owned or operated entity to a patient who is admitted as an inpatient within 3 days
Q6 Service furnished by a locum tenens physician

We have tried adding a 59 modifier but the claims are still rejecting. Does anyone have any tips they can offer on how to get these claims paid? :confused:
 
Is the Heparin used as the infused drug or the drug to open/flush the port?

Drug supplies don't necessarily bundle to the administration code, but it's hard to tell if there is more information going on that isn't shared in your post. Such as is another drug infused at the same session?
 
Heparin and IV Infusion

Thank you for responding! We finally spoke to someone who was helpful at Medicare today. The Medicare rep said to add a 59 modifier to J1644 and then the claim will pay. Medicare said the change was effective 10/1/2014. On Encoder Pro 59 is not a valid modifier for J1644 but according to Medicare this is a new change as of October 1st of this year. They said there is no policy for the changes, so unfortanately we have no documentation to back it up is the only other issue.
 
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