# Coding for cortisone injections?



## mksmith713 (Mar 4, 2009)

If my Doc injects a knee with 5cc 1% Lidocaine, 3cc .25% Sensorcaine and 2 cc of Kenalog 40mg/ml.
How would I code the supplies?
Would it be a simple J3301, would it be J3301 x 2 or something altogether different?


----------



## Bella Cullen (Mar 5, 2009)

If this was done in the office, yes I would code for the supply. In that case I would code J3301 x4 units for the 40mg of Kenalog. Because if you look in the HCPCS book under J3301 it says per 10mg. 
You just can't code supplies when done as Inpatient or Outpatient in the hospital.
Hope this helps.


----------



## mksmith713 (Mar 5, 2009)

OK, here's the problem.
The dosage is 40mg/ml.
The amount in the vial is 10mg.
The patient isn't getting 40 mg or cc's of the cortisone, they're only getting 2 cc's.
This is where the confusion lies.

If what you're saying holds true, would I only bill J3301 x 2 if I used 2 cc of Kenalog 10 ?
If using 2 cc of Kenalog 40, I should be able to bill J 3301 x 8 ?

The insurance carrier is only paying $1.50 for J3301
Each vial of Kenalog 40 contains 10 cc or 10 1cc doses.

If I do the math...I get J3301 x 4 for each cc or $6 for each cc
The total value of each bottle is $60.00
We pay $58.00 per vial.
There is absolutely No profit margin.
No logic here.


----------



## mksmith713 (Mar 5, 2009)

This has me wondering, does a 500mg Tylenol tablet bill out at a higher rate than a 350mg Tylenol tablet?........


----------



## mksmith713 (Mar 5, 2009)

I didn't even consider the cost of 1- 18ga needle to draw the meds, 1- 25ga needle to inject, 1- syringe, alcohol preps to wipe the vials and clean the betadine from the patient after the injection, betadine to prep the injection site, a 4x4 to clean and dry the site in preparation of the bandaid....oh, and let's no forget the bandaid.

OK, so now we just did a cortisone injection on a patient and we LOST money.

How do we fix this?


----------



## mksmith713 (Mar 5, 2009)

Crap, I forgot the Lidocaine and Marcaine....
That costs too..

Are we seeing anything concernig or parhaps even alarming here?

OK, beisde my beancounting?


----------



## Bella Cullen (Mar 6, 2009)

I'm not sure about your math logic. I've just always billed J3301x4 units for Kenalog 40mg and J3301x8 for Kenalog 80mg. Since it's per 10mg. 
I also bill out an injection code with the supply. I just assumed you do too. Not just the supply alone. For the injection code we usually use 20610 or 20551.  
Daisy


----------



## mksmith713 (Mar 7, 2009)

I bill for the injection code as well but that's a procedure code, not a supply code.
You should NEVER break even or lose $$$ on supplies.


----------



## mksmith713 (Mar 7, 2009)

Let's try this analogy....
If you take you car to a mechanic to have the brake pads replaced, you're going to pay for the pads, brake fluid and other small misc parts.
You're also going to pay for Labor.
This is the same thing.
If the mechanic has to buy the brake pads,fluid and misc parts from a distributor, and it cost the mechanic $100. for those parts, do you think he's going to charge you $80.00 for the parts?|
NO, he's probably going to charge you $150.00 for those parts.
OK, that's just the J3301 part.


----------



## mksmith713 (Mar 7, 2009)

The 20610 anaolgy is that the mechanic also going to charge you about $60.00 per hour for labor to do the work.

Simple analogy.....
J3301 = Parts
20610 = Labor


----------



## Lisa Bledsoe (Mar 9, 2009)

mksmith713 said:


> Crap, I forgot the Lidocaine and Marcaine....
> That costs too..
> 
> Are we seeing anything concernig or parhaps even alarming here?
> ...



FYI - you can't code/charge for lidocaine and marcaine.


----------



## mksmith713 (Mar 9, 2009)

DaisyAnn said:


> I'm not sure about your math logic. I've just always billed J3301x4 units for Kenalog 40mg and J3301x8 for Kenalog 80mg. Since it's per 10mg.
> I also bill out an injection code with the supply. I just assumed you do too. Not just the supply alone. For the injection code we usually use 20610 or 20551.
> Daisy


I think the math is correct.
If I inject 1 cc of Kenalog 40, the code would be J3301 x 4
If I inject 2cc of Kenalog 40, the code will be J3301 x 8

Is this how you'd code it?


----------



## Bella Cullen (Mar 10, 2009)

mksmith713 said:


> I think the math is correct.
> If I inject 1 cc of Kenalog 40, the code would be J3301 x 4
> If I inject 2cc of Kenalog 40, the code will be J3301 x 8
> 
> Is this how you'd code it?




Yes, that is correct. Kenalog 40 (J3301x4), Kenalog 80 (J3301x8). We just say Kenalog 80mg instead of 2cc Kenalog 40mg. 
I'm sorry, your logics were just confusing to me. I hope you are clear now.  
Have a great day!!


----------



## mksmith713 (Mar 13, 2009)

The thing with saying Kenalog 80 is that it's not even close to being accurate.
The designation Kenalog 10 or 40 is derived from the amount of steroid in mg/ ml in the solution.
Kenalog 10 has 10mg per ml of cortical steroid in the solution.
Kenalog 40 has 40mg per ml   "    "          "        "        "      .
So calling it Kenalog 80 is inaccurate.
It should be called 2cc of Kenalog 40.

I guess, if it makes it easier for you to SAY it that way, please feel free to do so.

I know, being too nitpicky....


----------



## Bella Cullen (Mar 13, 2009)

Oh, well that is how the plastic surgeons called it that I used to work for and now the ortho surgeon I work for call it Kenalog 80. So that is how I was taught. I never went by cc's.


----------



## mksmith713 (Mar 13, 2009)

As long as J-3301x8 goes on the billing form, doesn't really matter.


----------



## mksmith713 (Mar 13, 2009)

BTW, has anyone else checked their cost for supplies vs. what the payers are reimbursing?

Is anyone else losing money?


----------

