Internal Medicine Coding Alert

Question: Our physicians often use a local anesthetic or a mixture of triamcinolone and lidocaine when performing a nerve block or joint injection. I've always heard that we couldn't bill separately for the anesthetic, but now a new provider in our group believes it's billable. Can we code for the lidocaine?

Arkansas Subscriber

Answer: Physicians commonly use lidocaine as an anesthetic during nerve blocks or joint or soft tissue injections, but that doesn't make it billable. HCPCS deleted the code for lidocaine in 2005 and payers currently consider lidocaine inclusive to the injection and not separately billable. According to Section 50 (L) of Chapter 12 of the Medicare Claims Processing Manual, "There is no CPT® code for the performance of local anesthesia as payment for this service is considered in the payment for the underlying medical or surgical service."

Consider: Your physician might be thinking of lidocaine that is administered intravenously, typically when treating cardiac arrhythmias. In that scenario, you can report J2001 (Injection, lidocaine HCl for intravenous infusion, 10 mg).