New NCCI Edit Bundles J2001 With FNA Codes

If your endocrinologist performs a fine needle aspiration (FNA) for a thyroid biopsy and gives the patient an anesthetic lidocaine injection at the same time, you shouldn't report J2001 to account for the drug.
That's the word from the latest version of the National Correct Coding Initiative, version 10.2. The new edition of NCCI added an edit that bundles J2001 (Injection, lidocaine HCl for intravenous infusion, 10 mg) with 10021 (Fine needle aspiration; without imaging guidance) and 10022 (Fine needle aspiration; with imaging guidance), citing a misuse of the J code as the reason.
Background: Coding experts speculate that this new edit probably stems from the past misuse of J2000 (Injection, lidocaine HCl, 50 cc), which CMS previously deleted and replaced with J2001. Coders would read "lidocaine injection" and instantly select the code, without first considering the actual method of administration and/or dosage the physician used, says Judy Richardson, MSA, RN, CCS-P, senior consultant with Hill & Associates in Wilmington, N.C. Coders were using J2000 to report local anesthetic for wound care and a plethora of other services, and this led to gross abuse of the code, she adds.
New code: With the introduction of J2001, coding experts suspect that CMS is trying to stop coders from inappropriately reporting local anesthesia with a J code. "Local anesthetic is usually bundled in with a procedure," Richardson notes. The new NCCI edit bundling J2001 with 10021 and 10022 is likely an attempt to reinforce the fact that local anesthesia is not separately reportable.
Common practice? Do endocrinologists commonly administer an anesthetic lidocaine injection for a thyroid biopsy? That all depends on the physician, says Karen Potts, RN, a nurse in the ultrasound department at Thomas Jefferson University Hospitals in Philadelphia where physicians frequently perform thyroid biopsies. Some physicians will give a local lidocaine injection in the skin, but others won't use anesthesia at all, she says. Many physicians don't bother with lidocaine because the injection tends to hurt more than the rest of the FNA, says Mark Yocono, MD, with The Endocrine Group LLC, in Albany, N.Y.
Don't Rush to Separate the Edits With -59
The new NCCI edit lists a "1" in the modifier column, indicating that you may use modifier -59 (Distinct procedural service) to bypass the bundling edit under certain circumstances. But CMS has not yet specified what circumstances might merit separate payment for J2001, Richardson says. However, because J2001 refers to 10 mg of intravenous infusion, which physicians normally only administer to cardiac patients, there is almost no chance that your endocrinologist can justify using this amount of lidocaine with an injection or biopsy.
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- Published on 2004-07-21