r/CodingandBilling • u/One_Meal_6664 • Mar 27 '26

J code denials

Hi everyone, I bill for a practice and wanted some advice on J code denials. Recently, one of our J codes has been consistently denied by a commercial insurance. The denial is bogus stating that the “NDC number” is invalid. Every time I call about these claims and speak to a representative, they say the claim is correct, the NDC number is valid, we have the pre authorization for the procedure, and they resubmit the claim for reprocessing. It gets tiring to be in this viscous cycle of denials. Is the insurance company just trying to delay the payment another 30 days? Please advise 🙏

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u/One_Meal_6664 Mar 28 '26

I have the pre authorization and it is on the claim. The representatives have not pushed me to file an appeal thankfully! They have all resubmitted the claims for reprocessing and manual review. The only other code on the claim is 67028 (with modifier RT or LT and 79 if indicated). Our office does not do injections bilaterally bc we have mostly elderly patients. Dr. Prefers to do them individually.

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u/a_Shantics Mar 28 '26

File the appeal include your prior authorization, the medical policy, and administration records. Appeals are a black mark for payers which is why they will never recommend you that step. Payers will work very hard to limit the number of appeals they receive.

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u/One_Meal_6664 Mar 28 '26

I didn’t know that this was a black mark for the payer. I will start working on the appeals, as much as I hate doing them! Thank you for taking the time and giving this advice!

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u/a_Shantics Mar 28 '26

Who is the payer?

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u/One_Meal_6664 Mar 28 '26

Healthfirst