When a 'not otherwise classified' or 'unlisted' HCPCS procedure code is submitted and there is a specific procedure code for that particular injection, radiopharmaceutical or injectable contrast material, the service will be rejected. This is applicable to HCPCS codes J3490, J3590, J9999, A4641, A9699 and A9700. Rejected claims must be submitted as new claims.
Scenario 1
Substance administered: 0.9% Normal Saline
Dosage: 1000 cc
| Correct or Incorrect | HCPCS Code | QB | Item 19 |
| Incorrect |
J3490 |
1 |
0.9% normal saline, 1000cc |
| Correct |
J7050 |
4 |
Nothing |
Scenario 2
Substance administered: Vitamin B12
Dosage: 1,000 mcg/ml
Correct or Incorrect | HCPCS Code | QB | Item 19 |
| Incorrect |
J3490 |
1 |
Cyanocobalamin, 1,000 mcg/ml |
| Correct |
J3420 |
1 |
Nothing |
Scenario 3
Substance administered: Dactinomycin
Dosage: 3cc/0.5mg
Correct or Incorrect | HCPCS Code | QB | Item 19 |
| Incorrect |
J9999 |
1 |
Actinomycin D, 3cc/0.5mg |
| Correct |
J9120 |
1 |
Nothing |
Scenario 4
Substance administered: DTPA
Dosage: 1 vial
Correct or Incorrect | HCPCS Code | QB | Item 19 |
| Incorrect |
A9699 |
1 |
DTPA, 1 vial |
| Correct |
A9515 |
1 |
Nothing |
Scenario 5
Substance administered: I-131
Dosage: 1 millicurie
Correct or Incorrect | HCPCS Code | QB | Item 19 |
| Incorrect |
A9700 |
1 |
I-131, 1 mci |
| Correct |
A9533 |
1 |
Nothing |
last updated on 08/31/2009