cpt code - j7613, j7609
DESCRIPTION OF THE ISSUE
Claims filed without or
incorrect NDC#s, MCD HMO carriers (Staywell/Health Ease) rejected entire claim
for NDC# updates, instead of processing denial only for J Codes.
CONCEPT
All injection drug
codes should be billed along with NDC# updates for the claims to be reimbursed.
SOLUTION
Carriers’ database setup has been modified to
reject the entire claim when filed with J Code without/Incorrect NDC#s, instead
of processing denial only for the J Code. So we segregated J code as a
separate claim. This enhanced payment for rest of the CPTs and the J code
alone was denied for need of NDC#.
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