Ophthalmology and Optometry Coding Alert

Question: Is there a code we should bill for subcutaneous lidocaine or lidocaine with epinephrine during an office procedure? Some of the ophthalmologists in our group are asking for a code on the superbill, while others think we should count it in the procedure code. Should we bill separately for the lidocaine injections?

North Dakota Subscriber

Answer: The physicians in your group who state that the lidocaine injections should be counted as part of the procedure are partially correct. Medicare specifies that local anesthetic use is "an inherent surgical procedure component, and is not billable separately."

Medicare includes all "surgical anesthesia" administered by the operating surgeon as part of the surgical package and not a payable service. There are many private, non-Medicare or commercial insurance carriers, however, that will pay for anesthesia blocks but not for topical or local anesthesia. For these carriers, you can separately bill for any anesthesia blocks administered by the operating surgeon.

The only code for lidocaine is J2001 (Injection, lidocaine HCl for intravenous infusion, 10 mg). In 2004, CMS deleted J2000 (Injection, lidocaine HCl, 50 cc), which many practices were inaccurately using to bill for injected lidocaine. When coding for Medicare, you cannot consider J2001 the same way, however, because the code descriptor specifies that the physician must administer the lidocaine via an IV infusion to use this code. In fact, the Correct Coding Initiative (CCI) bundles J2001 with many minor procedure codes to specifically prevent you from reporting it with an injection code.

Alternative: For non-Medicare carriers, consider using S0020 (Injection, bupivacaine HCl, 30 ml, use this code for Marcaine, Sensorcaine) for billing the drug itself when your physician administers it in the office setting.

-- Advice for You Be the Coder and Reader Questions provided by Maggie M. Mac, CPC, CEMC, CHC, CMM, ICCE, director, Best Practices-Network Operations at Mount Sinai Hospital in New York City.