Orthopedic Coding Alert

In the March 2001 issue of Orthopedic Coding Alert, we printed a reader question and answer on coding for Marcaine injections. One of our readers, Dana Brooks, practice manager for the Alabama Hip & Knee Center in Birmingham, Ala., wrote that she would have liked a more detailed answer to the question of how to code for Marcaine supply.

Heidi Stout, CPC, CCS-P, coding and reimbursement manager at University Orthopedic Associates in New Brunswick, N.J., expands on the original question.

When seeking reimbursement for injectable drugs, there are two questions the coder needs to know the answers to at the outset. Does the carrier pay for injectable drugs, and if so, do they pay for anesthetics? Unfortunately, not many carriers do, and the cost of the drug supply must be built into the procedure charge for the injection.

If the carrier does pay for anesthetic injectables, the coder must ask the carrier whether they process claims for injectables using HCPCS J codes or the NDC (national drug code) number printed on the drug package. Our office has had to use both of these classification systems depending upon the carrier, Stout says. If a J code is used, then J3490 (unclassified drugs) is fine, but because it is an unclassified drug code, a description of the medication and its dosage will have to appear in the comments section for electronic claims submissions, or the description-of-service area of the claim form.