Oncology & Hematology Coding Alert

Be accurate on units for HCPCS codes.

Do you think you’re a corticosteroid injection coding expert? Find out by comparing your answers to ours.

Check Site of Injection

Answer 1: The correct answer is option A) 11900.

You should report CPT^® code 11900 (Injection, intralesional; up to and including 7 lesions) when your physician injects steroids in seven or less lesions in the skin. This code describes an intralesional injection of a corticosteroid, such as triamcinolone acetonide (Kenalog), for treatment of large nodules, keloids, lichenified hyperkeratotic lesions, and numerous other conditions. For more than seven lesions, report 11901 (… more than 7 lesions).

Code 11951 (Subcutaneous injection of filling material [e.g., collagen]; 1.1 to 5.0 cc) is for subcutaneous injections of collagen, and code 11980 (Subcutaneous hormone pellet implantation [implantation of estradiol and/or testosterone pellets beneath the skin]) is for subcutaneous implantation of hormone pellets. Code 19357 (Breast reconstruction, immediate or delayed, with tissue expander, including subsequent expansion) is for breast reconstruction.

Determine POS for HCPCS Codes

Answer 2: The correct answer is option B) J1100 (Injection, dexamethasone sodium phosphate, 1 mg) to report 1 mg of dexamethasone (Decadron).

You report codes J3301 (Injection, triamcinolone acetonide, not otherwise specified, 10 mg) and J3300 (Injection, triamcinolone acetonide, preservative free, 1 mg) for triamcinolone acetonide (Kenalog). For triamcinolone diacetate (Aristocort), you report code J3302 (Injection, triamcinolone diacetate, per 5 mg). Code J0702 (Injection, betamethasone acetate 3mg and betamethasone sodium phosphate 3 mg) is for betamethasone.

Tip: You will not always be able to separately bill for the supply of drug. The place of service (POS) will dictate when the professional (CMS 1500 claim) can submit for reimbursement of the supply. Only when your physician purchases the medication and administers the same in the office, you opt for place of service code 11. If the physician provides the injection in a hospital or other facility, the facility bears the cost of the medication and would bill for the supply of the medicine. In the latter scenario, your physician can submit the administration code.

Also remember: If the medication given in the physician’s office (POS 11) represented no cost to the practice, reimbursement cannot be sought for that particular supply and should be filed with a charge of $0.

Check the units: Pay attention to the code descriptors when reporting units. For J3300, you should report 1 unit per 1 mg. In contrast, you should report 1 unit per 10 mg for J3301.

The amount of the drug administered may be expressed in the documentation as cubic centimeters (cc). Most often, when you come across any such documentation, you will need to determine the amount of milligrams (mg) administered. It is important to understand cubic centimeters are a measure of volume and milligrams are a measure of weight. There is no consistent way to convert cubic centimeters to milligrams as one drug might have 30 mg per 1 cc and another might have 50 mg per 1 cc. Before you submit the HCPCS code, you will need to confirm how many milligrams of drug your physician administered.

As with anything, there are always exceptions. Few medications, such as some immunoglobulin and mannitol are expressed as ‘cc’ to determine the number of units to bill. Always verify the official HCPCS code description to determine the calculation to units that must be done for accuracy.

Note: You would use the same HCPCS code regardless of whether your physician used the brand-name or generic name. Kenalog is the brand name, and the generic drug name is triamcinolone acetonide. The HCPCS tabular listing is arranged by generic drug name. If you look up triamcinolone acetonide in the index, you’ll see it lists J3300 and J3301 as the proper codes. You choose from these codes depending upon which salt (acetonide or diacetate) your physician administered. Be aware that J3300 is for the preservative-free formulation and matches to different brand names. The HCPCS drug table listing contains brand names, as well. When you look up Kenalog, it refers you to triamcinolone acetonide.

Count the Number of Lesions For 11900

Answer 3: The correct answer is option D) 1 unit.

You submit only one unit of code 11900 as your physician is treating two lesions. CPT^® code 11900 specifies the number of lesions treated, up to and including seven. If your physician treated eight or more lesions, you would report one unit of 11901.