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J3490 and Compounded Drugs

Jared Posted Wed 13th of November, 2013 18:30:19 PM

One of our DO's does intrathecal pain pump management. Recently, we have been getting conflicting information from insurance companies regarding the proper way to bill for the drugs we inject into the pumps. The supplier of our drugs gives us a printout with the NDC codes and Jcodes for each individual drug in the mixture they send us. We used to bill each individual drug this way, but then we were told that insurance companies want you to bill such drugs under the J3490 Unclassified Drugs code and then supply the invoice for the drugs when they request further info. We have made the switch to this, but now almost every insurance denies every pump refill except for Medicare. When we call these insurances they tell us to bill "per Medicare guidelines", but that they are not setup to handle the J3490 code the way Medicare does. Any ideas on how to break this stalemate?

SuperCoder Answered Thu 14th of November, 2013 01:07:01 AM

For Medicare please check http://wpsmedicare.com/j5macpartb/claims/submission/billing-refills-pumps.shtml

It would be in your best interest to look at the LCD for your area. Then just send whatever is listed under the documentation requirement section for that LCD.

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