Wiki LCD Guidelines for J3420 -- UNITS

[SSMcElyea-Vironet]

I am having a lot of problems lately getting J3420 paid. Here's how we'll bill it:

J3420 x2 units
96372

Medicare keeps giving us a rejection of CO151. I finally got some info out of a Medicare rep that it has to do with the Units billed. I noticed that when we bill J3420 x1 unit.. it gets paid. We're billing the correct DX code too. I checked LCD for that. 281.0. BUT, the LCD doesn't give me anymore information than that on really how many units the pt can receive. I've read on a coding site one time say limit is once per month...I get that...need info on the UNITS.

CAN SOMEONE PLEASE HELP ME WITH THIS? If anyone has a link to anything that can tell me Units that is allowed and so forth. I know we can get this paid. Just want to know how! Furthermore, if we can only bill for 1 unit. I need the info to share with our physicians.

HELP!

Thanks!

Sarah, CPC

 

[SueTeal]

The J3420 code in HCPCS says 'up to 1000 mcg'. How much is the patient being given? I think you might find in the majority of the cases that you do not go over 1000 mcg. Therefore 1 unit should be sufficient. Does this make sense?