Getting Paid for Hyalgan and SynVisc Injections
Published on Fri Jan 01, 1999
As of Jan. 1, 1999, there are finally specific level II HCPCS codes for both Hyalgan and SynVisc. And although orthopedic practices dont have to worry as much about claims being denied for these injections given to patients in 1999, many offices have numerous outstanding claims from 1998 that they are still tying to get paid.
Many orthopedic practices have been having difficulty receiving reimbursement for these injections. The reason for these problems, according to Jeri Harris, CPC, CPC, H, member, National Advisory Board for the American Academy of Professional Coders, and coding specialist and staff compliance officer of Orthopedic Specialists, Charleston, SC, has been the lack of specific codes. There is also confusion about which CPT codes to use, whether Hyalgan and SynVisc are drugs or medical devices, and about the correct supporting diagnosis codes. By considering how this treatment is used, the coder can improve reimbursement for this important orthopedic therapy.
HCPCS and CPT Unlisted Codes
If your practice is having trouble getting reimbursed for injections of Hyalgan and SynVisc given prior to Jan. 1, 1999, you should code for these injections as unlisted drugs, Harris says. This can be a real hassle, she adds, because of the lack of carrier understanding and the amount of paperwork involved. But she also suggests that coding for unlisted drugs is something the orthopedic coder must understand, because orthopedic therapies continue to develop faster than the codes that describe them. Harris recommends a couple of different ways of coding for unlisted drugs.
One approach is to use the HCPCS book codes. The HCPCS manual is based on the Health Care Financing Administrations (HCFA) Common Procedure Coding System. The book contains Medicares National Level II Codes, such as injection drugs, durable medical equipment, etc.
The HCPCS book gives several separate unlisted drug codes, each of which signifies a specific description to the insurance carrier. Some examples are as follows:
J3490 - unclassified drug that is administered by a method other than orally (i.e., intramuscularly, subcutaneous or intravenously).
J7599 - immunosuppressive drug that is not otherwise specified.
J8999 - chemotherapeutic prescription drug given orally that is not otherwise specified.
J9999 - antineoplastic drug given by infusion for oncology therapy.
For each of the above unclassified or unlisted drug codes, regional Medicare carriers have ideas as to what they will pay and how they want the items to be billed. If a regional Medicare carrier has its own HCPCS Level III code, that code must be used. Many regional Medicare carriers require companion information when you submit your claim. They may require that you give them the national drug code number and the dosage (units) on line 19 of the HCFA 1500 claim form.
Note: National [...]
