Wiki j3490 correct coding info

[ilvchopin]

Hi everyone, Happy New Year!! Hope it will be a happy and healthy one!
does anyone know if there is a new way to code for J3490? My office is gastro/anesthesia.so billing out propofol. I got a rejection on the j code saying something about the "unit should be one"? not sure what they are talking about..always put 1 for one vial in the unit box or 2 etc if nec?..this rejection was for 1 in the unit box though..do I need to use ndc# at all anymore? Any help would be appreciated. Thanks.

 

[dwaldman]

I saw this link, thought I would forward.

http://www.wpsmedicare.com/j5macpartb/departments/claims/j3490billingtips.shtml

J3490 (Not Otherwise Classified (NOC) HCPCS Code): Billing Tips
Recently, Wisconsin Physicians Service (WPS) Medicare Part B received an inquiry regarding the use of HCPCS code J3490 (a Not Otherwise Classified (NOC) Code). The following are tips to help you when billing J3490.

In order for WPS Medicare to correctly reimburse NOC J3490, providers must indicate the following in the electronic narrative, line level 2400 loop NTE segment, or Item 19 of the CMS 1500 form:

The name of the drug,
The total dosage (plus strength of dosage, if appropriate), and
The method of administration; and
List the units of service as one in 2400/SV1-04 data element of the ANSI X12 4010A1 or in item 24G of the CMS 1500 form.
As you may know, pricing for NOC J codes is determined by the information provided on the Average Sales Price (ASP) NOC pricing file. If the ASP NOC file lists the strength for a drug on the file, this indicates that the drug comes in different strengths. Medicare payment varies depending on the strength given. In this situation, providers should list the name of the drug, strength of the drug, the amount of the drug administered and the method of administration.

When billing Medicare for a NOC J code, you can determine if the drug comes in different strengths by accessing the ASP NOC pricing files. You can access the files on the Centers for Medicare & Medicaid Services (CMS) website(external link)