Learn J3301 Billing and Know if Ability to Bill the Patient Expire

J3301

Generic vs. Brand Name Won't Alter Your J3301 Billing

Question: Your doctor is using Kenalog 40 (NDC 0003029328) from Bristol Meyers Squibb. He says HCPCS code J3301 is not the accurate code to bill as that is a generic code. Is there a different code to distinguish generics from non-generic when billing?

Answer: For Kenalog injections, you must use J3300 (Injection, triamcinolone acetonide, preservative free, 1 mg) or J3301 (Injection, triamcinolone acetonide, not otherwise specified, 10 mg) for the Kenalog itself.

Pointer: Be wary of the code descriptors while reporting units. For HCPCS code J3300, you must report 1 unit per 1 mg. On the other hand, you must report 1 unit per 10 mg for J3301.

These are the codes you should use, irrespective of the company you get the Kenalog from. Kenalog is actually the brand name whereas the generic drug name is triamcinolone acetonide. The HCPCS tabular listing is decided by generic drug name. If you look up triamcinolone acetonide you'll see it lists HCPCs code J3300 and J3301 as the proper codes. The HCPCS drug table listing comprises brand name as well. When you search Kenalog it eventually refers you to triamcinolone acetonide.

Does Ability to Bill the Patient Expire?

Question: Is there a time limit on when you can bill a patient for their balance due after the insurance company processes the claim? For instance, in case the patient still owes a balance (according to insurance's allowed charges) after two or three years, are you able to still bill the patient?

Answer: There is no national regulation that restricts when you can bill a patient. You must check your state's laws, nevertheless, to make certain there is nothing specific to your area that places a time limit on when you can bill a patient. You should also check your payer contracts to be guarantee there is no requirement you have agreed to by signing as a participating provider.

Medical Coding and Billing Tip: Just for the reason that there is no time limit, that doesn't mean it is the best thing to bill a patient for the first time three years after she had a procedure or service. In case you upset a patient by billing her for the first time a long time after the service -- which possibly meant she believed she didn't owe anything for the reason that you had not sent a billing statement -- you may lose a patient and will probably have difficulty collecting the fee.

As per medical coding and billing experts, an unhappy ex-patient is right to tell anyone who will listen that your practice is bad news. She may even go ahead and complain to the state medical board and get you investigated for your business practices. You must consider the public relations effect of billing three years after a service.




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