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PLAIDMAN

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Really need some direction on who I can get an answer from:

Rep sold my docs "injection kits" which includes :
40mg depo Medrol
lidocaine
gloves
bandaid

the reps are telling my docs to use unlisted code for billing J3490 and charging about $ 900

I have told my docs you cannot bill for "gloves" "bandaid" and that you would never use an unlisted code when there is a cpt code for procedure....
(20610 + J1030)

I have emailed a couple "experts" who cannot/or have not answered me.

WHO CAN I CALL ? I don't know what to do ?
 
New codes seem to be coming out all the time. Maybe it's what's required for that particular Kit. I think you're doing the right thing asking about it though.
 
If there is no bundled code for the package but you can code for the parts... I would be incredibly careful using an unlisted procedure code to try and bundle it all together. You have to prove why you are using that code... Unlisted procedure codes should only be used if there truly is not an appropriate way to capture the services in HCPCS/CPT.

It's also inappropriate to bill for topical anesthesia and supplies that are inherent to a procedure (which you've pointed out to your doctors). I don't know all the details of what your doctors are doing and without it all I don't know for sure however to me this doesn't sound like you should be using an unlisted procedure at all. You should be billing for the services performed which would be the injection and the supply code which there exists a code for the inject-able. Again, I cannot say 100% because I don't have the documentation in front of me but that's what I think from what you've supplied.
 
I agree with you Daniel. Without more information we can't give a definitive answer. Just like you can't assume to code Unlisted Procedure for something that might be more precise.
 
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