Medicare Compliance & Reimbursement

When it comes to Synvisc, ignore HCPCS 2007.

Orthopedic coders were surprised to find the Synvisc and Hyalgan code J7317 missing from HCPCS 2007, and relieved to find the replacement code J7319 in its place. But don't get too comfortable with J7319 -- the code has already been deleted and replaced with four "Q" codes that describe various drugs the physician may inject.

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.

News flash: 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

Make Sure Your Insurer Is In On The News

"Not only has the sudden deletion of J7319 taken coders by surprise, but it has also taken many insurers by surprise as well," says Heather Corcoran, coding consultant with CGH Billing in Louisville, Ky. "Some insurers are still telling practices to report J7319 because their computers are not up-to-date, so if you receive denials for 2007 claims with the 'Q' codes, you should appeal."

As always, you should report the applicable administration code as well as the HCPCS code when the surgeon injections sodium hyaluronan.

For instance: "Generally our surgeons use Synvisc for patients who have osteoarthritic knees, and have not responded well to taking anti-inflammatories, or who have received traditional cortisone injections in their knees without relief," says Melanie Reichart, supervisor of billing and coding at Orthopaedic Associates of Rochester in New York. 

If the surgeons perform a Synvisc injection into the knee, "we use code 20610 (Arthrocentesis, aspiration and/or injection; major joint or bursa [eg, shoulder, hip, knee joint, subacromial bursa]) for the administration of the drug," Reichart says.