Upon redetermination, the J3490 (Famotidine) remains denied stating "it is part of another service that was performed at the same time". I'm assuming they are bundling the J3490 into the other drugs? Isn't that how outpatient hospital (POS 22) chemo works for certain premeds?
This is part of a claim for chemotherapy performed in the physician's office with POS 11.
The DOS was initially split onto two claims causing a processing problem because the chemo drugs were separated from the nonchemo drugs and infusion codes (ugh, the problems late superbills cause!). The original processing resulted in the denial of 4 codes (96367 96413 96417 J3490). After the review of the redetermination, Novitas is paying the 96367 and 96417 but the 96413 and J3490 remain denied. (If it was just the J3490 left, I would even bother since the cost of that drug is so low.)
Whoever reviewed the redetermination apparently doesn't understand infusion/chemo coding. Without paying the 96413, there is no initial code for the DOS. Anyone else having increasing problems with Novitas like this? Do they contract out their reviews to another company? I miss Pinnacle!
What I'm hoping someone out there can provide for me is a reference that states that premeds cannot be bundled for physician office services.
Thanks!
This is part of a claim for chemotherapy performed in the physician's office with POS 11.
The DOS was initially split onto two claims causing a processing problem because the chemo drugs were separated from the nonchemo drugs and infusion codes (ugh, the problems late superbills cause!). The original processing resulted in the denial of 4 codes (96367 96413 96417 J3490). After the review of the redetermination, Novitas is paying the 96367 and 96417 but the 96413 and J3490 remain denied. (If it was just the J3490 left, I would even bother since the cost of that drug is so low.)
Whoever reviewed the redetermination apparently doesn't understand infusion/chemo coding. Without paying the 96413, there is no initial code for the DOS. Anyone else having increasing problems with Novitas like this? Do they contract out their reviews to another company? I miss Pinnacle!
What I'm hoping someone out there can provide for me is a reference that states that premeds cannot be bundled for physician office services.
Thanks!