Neurology & Pain Management Coding Alert

Question: Our physician often uses sodium bicarbonate when performing a transforaminal or facet injection. Can we bill for the sodium bicarbonate, or is this bundled into the procedure? Idaho Subscriber

Answer: If you perform the procedure in an ambulatory or outpatient hospital facility and the facility provides the medications, you won't bill for the sodium bicarbonate. If, however, your practice bears the cost of the facet injections (such as when the physician administers the injections in his office), then you can bill separately for the sodium bicarbonate. Report J3490 (Unclassified drugs). Medicare does not cover sodium bicarbonate, but other payers might.

Caution: Verify your physician's service before automatically reporting J3490. In an office setting, he might use sodium bicarbonate to increase the pH of an injectable medication to potentially eliminate some of the irritation associated with injecting a local anesthetic such as Lidocaine.

Most pain management providers would never administer the 50 ml usually associated with sodium bicarbonate packaging. Because of this, submitting an extra code for the sodium bicarbonate isn't necessarily appropriate.