Since you can not find or because there is no assigned HCPCS code for
Marcaine and Sodium Bicarbonate, you will end up using an unclassified code
for these two drugs using the J3490.
Based on my experience using J3490, many of my claims were denied
because of J3490. Insurance companies will deny our claims requesting
additional information for J3490. They are not actually asking for medical notes
related to the procedure, but they are requesting for the NDC number for
J3490. And let's face it, not many medical offices even knows what NDC
number means or how do they find the NDC number for both of these two
drugs. And even if they do have the NDC number, they do not know how to
place that number on the claim (ask your billing software provider!). I know that
many billing software would allow this NDC number plugged in on the 1500
HCFA form Box 19.
But honestly, billing J3490 for both of these drugs (which you don't have any
choice any way since there is no assigned code for these drugs) -- this is
where claims get delayed for payment, and if you don’t pay attention on the
denial, will not follow up or appeal on the claim, it will end up being unpaid and
will stay on your receivable forever.
Here is the worse part, when they deny J3490, they will also deny the entire
claim, inclusive with the primary procedure codes! I have seen countless claims
being denied because of J3490. And I think many of you will agree with me.
It is all up to you if you want to bill for J3490 for Marcaine and Sodium
Bicarbonate, but is it worth it for an expected reimbursement between 0.20
cents and a 0.75 cents per unit? I don’t think so! Well, as long as you document
it on your medical notes and medications record that Marcaine and/or Sodium
Bicarbonate was used on the procedure, I think it is worth it to leave these two
drugs unbilled with the claim.
**** For more references: Consult your CPT code books. The National
Correct Coding Initiative (NCCI) and third pary payer payment policies and
guidelines
*** another helpful article from Ms. Pinky
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