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Mike Posted Tue 20th of October, 2015 14:25:45 PM

We do Ketamine infusions Work comp paid for the infusion but denied J3490 for a Medicare HCPCS II code. Could you help me with that code?

SuperCoder Answered Wed 21st of October, 2015 10:58:33 AM

J3490 can be submitted only when a specific code for the drug is not available or does not exist. Claim form must include the below indicated informations in the remarks field/reserved for local use field of the claim form or on a separate attachment:
1. Name and Strength of Drug Administered,
2. Amount Given,
3. NDC Number.
If the name, strength and dosage administered of the drug are not all listed, the claim will be denied for lack of information necessary to process the claim. For billing of compounded drugs administered via implanted pump, submit a single combined line item for all drugs with HCPCS code J3490 and bill the combined charges for all drugs. So, check your reason for denial, appeal it again with proper documentation.

Mike Posted Wed 21st of October, 2015 16:06:07 PM

All that data was on the claim about the Ketamine. They don't like J3490. They think there is a specific J code.Do you see a J code that is for Ketamine?

SuperCoder Answered Mon 26th of October, 2015 03:15:34 AM

This is proper way to bill it. There is no such HCPCS code for ketamine specifically, J3490 need to be billed. Kindly check the reason for denial, we can work on that.

Mike Posted Tue 27th of October, 2015 10:24:54 AM

Thank you for the help. Work comp did not have the code so they just had to make a note I note in the case so we can get paid. Strange that they don't understand the coding yet they authorized the service.

SuperCoder Answered Wed 28th of October, 2015 04:17:43 AM

Ok. Means, it was an issue at their end. So, you can make them re-consider it. Furthermore, let us know for any kind of support related to this. We are happy to help!

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