Internal Medicine Coding Alert

Question: I've heard a few different answers on how we should report Synvisc injections. Which codes do you recommend when billing Medicare?


Tennessee Subscriber


Answer: Practices that code for sodium hyaluronate injections have good reason to be confused by the appropriate HCPCS code for this drug. CMS retired J7317 (Sodium hyaluronate, per 20 to 25 mg dose for intra-articular injection) at the end of 2006, although you should still report J7317 for any dates of service through Dec. 31, 2006.

Insurance carriers, as well as the 2007 HCPCS guide, then directed coders to report J7319 (Hyaluronan [sodium hyaluronate] or derivative, intra-articular injection, per injection) for any dates of service on or after Jan. 1, 2007
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However, on Dec. 20, 2006, CMS released its "2007 ASP Drug Pricing Files," which states, "For 2007, Medicare will recognize Q4083, Q4084, Q4085, and Q4086 for purposes of billing sodium hyaluronate injections ... These codes replace use of J7317, J7319, J7320, and J3490 (as applicable)."

The new codes are as follows:

• Q4083 -- Hyaluronan or derivative, Hyalgan or  Supartz, for intra-articular injection, per dose

• Q4084 -- Hyaluronan or derivative, Synvisc, for  intra-articular injection, per dose

• Q4085 -- Hyaluronan or derivative, Euflexxa, for  intra-articular injection, per dose

• Q4086 -- Hyaluronan or derivative, Orthovisc, for  intra-articular injection, per dose.

Therefore, even though J7319 appears in the HCPCS guide, it is a deleted code and is no longer applicable. Some insurers haven't updated their guidelines yet and are still telling physicians to report J7319, so if you get a denial for one of the Q codes, you should appeal.

As always, you should report the applicable administration code as well as the HCPCS code when the physician injects sodium hyaluronan, such as 20610 (Arthrocentesis, aspiration and/or injection; major joint or bursa [e.g., shoulder, hip, knee joint, subacromial bursa]).