Health Information Management

Q&A: Rejections for codes without internal edits

APCs Insider, April 24, 2015

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Q: We are receiving rejections for HCPCS codes J0365 (injection, aprotonin, 10,000 kiu) and J7180 (injection, factor xiii [antihemophilic factor, human], 1 i.u) when we report them on a claim. We are not receiving any internal edits for this.
A: These two codes had status indicator changes beginning April 1. J0365 had been assigned status indicator K (non-pass-through drugs and biologicals; paid under OPPS, separate APC payment) but has been reassigned to status indicator E (not paid by Medicare when submitted on outpatient claims).
J7180 was assigned to status indicator N (items and services packaged into APC rates; paid under OPPS packaged into payment for other services, no separate APC payment) and has been reassigned to status indicator K.
Editor’s note: Denise Williams, RN, CPC-H, seniorvice president of revenue integrity services at Health Revenue Assurance Associates, Inc., in Fort Lauderdale, Florida, answered this question.

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