Anesthesia Coding Alert

Question: Our payers have started denying J codes for Marcaine (bupivacaine). What are we doing wrong?

New Mexico Subscriber

Answer: If your provider uses Marcaine as a local anesthetic for an injection procedure and/or to lessen the patient's discomfort from another medication, most payers (including Medicare) will not separately reimburse the Marcaine. But if your provider uses Marcaine as one of the medications to refill an implanted infusion pump, some payers might process payment for that.

If you do report the drug, payers usually require J3490 (Unclassified drugs); other payers (such as some Blue Cross) require S0020 (Injection, bupivacaine HCl, 30 ml) instead.

Another tip: Check for your individual payer's requirements when filing J3490; many payers require specific information in box 19 or the electronic equivalent before processing the line item. Some examples include drug name, total dosage, administration route, or even the drug's NDC number.