Joshua Posted Thu 01st of March, 2012 22:09:55 PM
I am trying to use the FB modifier with Jcode 'J1440', does anyone know why this is/is not allowed? I see the FB modifier is acceptable with some Jcodes, or is it? What if the drug infused was provided by the patient or a sample?
SuperCoder Answered Thu 01st of March, 2012 22:17:23 PM
LEVEL II MODIFIER - FB
Description : Item Provided Without Cost to Provider, Supplier or Practitioner or a credit was received that covers the cost of the replaced device.
Required for Claims : Hospital Outpatient Claims subject to the Outpatient Prospective Payment System (OPPS)
Coding Guidelines :
1) Modifier –FB is used only when the manufacturer provides the item without cost or the hospital receives a full credit for the cost of the item.
2) Modifier –FB is always attached to the surgical procedure code, not the device code.
3) Modifier –FB should not be used when the hospital receives only a partial credit toward the cost of the item.
THE HOSPITAL MUST LOOK AT THE COST OF THE ITEM—NOT THE HOSPITAL’S CHARGE FOR THE ITEM.
General Guidelines :
Condition codes 49 & 50 are utilized to describe an item that is provided without cost to a provider, supplier or practitioner for use of items that are under warranty or defective:
49: Product Replacement within Product Life cycle
50: Product Replacement of a Known Recall of a Product
Joshua Posted Thu 01st of March, 2012 22:26:14 PM
Not quite the answer to the question.
The situation is that the Patient is purchasing the drug and bringing it to the chemo suite where the Oncologist is providing the infusion service. So, by definition the drug is an item provided to the provider without cost.
To submit thte claim, I need to append the Jcode to the Infusion code to identify what drug was infused, but I do not want to submit a charge for that drug since it was not bought by thet practice but rather the patient. When I do this with some codes (J0897 for example) the system allows the FB modifer and removes the charge, when I enter the J1440 or J1441 or some other codes, the sysetm states inproper use of modifier.
So it seems that the FB is allowable for some drugs but not all?
so angain the questions is how do I submit this so that the drug is not charged to the insurance company.
SuperCoder Answered Fri 02nd of March, 2012 09:31:24 AM
The code J1440 has ASC payment K2, which says: Drugs and biologicals paid separately when provided integral to a surgical procedure on ASC list; payment based on OPPS rate. It is also present in APC class 0728, with status indicator "K", meaning "Nonpass-Through Drugs and Nonimplantable Biologicals, Including Therapeutic Radiopharmaceuticals"... Not really sure why FB mod. is not accepted in case of this drug being used. Will try to gather more info on the same.
Joshua Posted Fri 02nd of March, 2012 16:06:02 PM
Amazing.. Thank you very much. any information is greatly appreciated.