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B12 Injection

William Ivan Posted Thu 25th of September, 2014 21:41:26 PM

We billed a 99215 (25 modifier), 85610 and a J3420 with a 96372 - DX code 266.9 for the injection.

All lines paid except the J3420. This is Florida medicare denial. Could you provide insight to why this did not pay.

SuperCoder Answered Fri 26th of September, 2014 07:37:48 AM

Thanks for your question. Per Florida Medicare Local Coverage Determination, the diagnosis code that you have billed 266.9 is not listed as a covered diagnosis for J3420. What is the denial reason that Medicare provided for that code?

William Ivan Posted Fri 26th of September, 2014 14:18:47 PM

CO-50 Non Covered Charges
N115 Based on LCD
M25 Payment has been denied

Could you point me to the allowable dx codes?

SuperCoder Answered Mon 29th of September, 2014 07:44:43 AM

Yes. You can find the diagnosis codes that are billable with J3420 using the Supercoder tool. Search for the code in the search field at the top right of the page. Under the Compliance Tools tab you are able to search for LCDs by geographic area, zip code, and contractor type. Enter the information for your locale and click find LCD. Choose the LCD for the contractor that you received your denial from and view the diagnosis codes that are billable with J3420. Hope this helps.

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