Don't have a TCI SuperCoder account yet? Become a Member >>

Regular Price: $24.95

Ask An Expert Starting at $24.95
Have a medical coding or compliance question? Don’t sacrifice your valuable time to endless research. Choose Ask an Expert to get clear answers from the TCI SuperCoder team. And here’s a tip for the budget-conscious: Select the 12-question pack to get the best rate per question!

Browse Past Questions By Specialty

+View all

Revenue Code- ASC

Nicole Posted Fri 13th of May, 2016 11:51:54 AM
What would be the appropriate Revenue Code for billing the Botox Injection (J0585) for an ASC? Would it be 0360? Also, would it need to be billed with a modifier -JW
SuperCoder Answered Tue 17th of May, 2016 02:28:47 AM
Payers typically connect J0585 to revenue codes 250 for pharmacy services and 636 for drugs requiring detailed coding. Individual payers may have specific polices requiring one or the other. 636: https://www.cms.gov/medicare-coverage-database/details/lcd-details.aspx?LCDId=33274&ver=5&SearchType=Advanced&CoverageSelection=Local&ArticleType=SAD|Ed&PolicyType=Final&s=All&CptHcpcsCode=j0585&kq=true&bc=IAAAABAAAAAAAA==&
Modifier JW requirements can vary by payer as well (although a national policy has been announced for Medicare, set to take effect in July): https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM9603.pdf
Also, J0585 has the status "Drugs and biologicals paid separately when provided integral to a surgical procedure on ASC list; payment based on OPPS." Presumably, the ASC confirmed the surgery was on the ASC list before performing.
Nicole Posted Thu 30th of June, 2016 10:46:11 AM
I cannot view the links that were sent above. Can you resend please. Also, do you have any links to information on the Revenue Codes as far as explaining when/how they should be used. For example, the Botox, you gave revenue codes 0250 and/or 0636 that could be used. Which one is the proper one or the best option?
SuperCoder Answered Fri 01st of July, 2016 04:02:27 AM
Please find below link for J0585 to revenue codes 250 for pharmacy services and 636 for drugs requiring detailed coding. Individual payers may have specific polices requiring one or the other. https://downloads.cms.gov/medicare-coverage-database/lcd_attachments/26765_51/Article4I84ABR13BotulinumToxinTypesAandB.htm
https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM9603.pdf

Related Topics