Orthopedic Coding Alert

If you've billed J2001 with your injections, the latest NCCI edits will get your attention If your practice reports J2001 for lidocaine when you perform injections, expect a flood of denials starting July 1.

Although most payers already bundled lidocaine payment into your injection fees, a new National Correct Coding Initiative (NCCI) edit confirms that you should never bill J2001 unless you treat a patient for cardiac arrhythmia. HCPCS deleted J2000 (Injection, lidocaine HCl, 50 cc) this year and introduced J2001 (Injection, lidocaine HCl for intravenous infusion, 10 mg) in its place. Although most coders accurately took this as a sign that Medicare would no longer allow them to report lidocaine for the small amount of anesthetic that they injected for local anesthesia or pain management, some coders simply changed their claim forms and started billing J2001 with every lidocaine injection. Lidocaine Has a Long Edit History NCCI version 8.1 bundled J2000 into several injection codes (such as 20526-20610), which seemed to stop many orthopedic practices from billing lidocaine with trigger point injections (20552-20553) and joint injections (20600-20610). At the time, Georgia Medicare's lidocaine policy, for example, stated, "The dosage indicated by the code description is specific to the treatment of cardiac arrhythmias and emergencies only. The billing of J2000 is not appropriate for the 1-2 cc usually required for a local anesthetic."

But when HCPCS introduced J2001, the code breathed new life into the lidocaine debate. NCCI version 10.2, effective through Sept. 30, shuts the door on any ambiguity, bundling J2001 into hundreds of codes, including trigger point injections, spine injections, bursa injections and scores of other codes. Remember: "The injection of a 'caine' while doing a joint injection is for pain control and shouldn't be billed separately," says Denise Paige, CPC, coding manager at Beach Orthopedic Associates in Long Beach, Calif., and president of the American Academy of Professional Coders'Long Beach Chapter. "There are those who think that this never should have been billed separately in the first place, and after J2000 was deleted I think that further backs up that theory. I now only bill for the joint injection and the cortisone." J2001 Bundle Doesn't Stop With Injections The new version of NCCI doesn't just bundle J2001 into injection codes. You will face denials if you report J2001 with most musculoskeletal codes, including several fracture care codes (such as 25611, 27538, 28124 and many others), biopsy codes (including 24065) and bone excision codes (such as 28124). NCCI Bundles Arthroscopic Surgeries NCCI 10.2 includes a mutually exclusive edit that bundles 11010-11012 (Debridement including removal of foreign material associated with open fracture[s] and/or dislocation[s] ...) into 29827 (Arthroscopy, shoulder, surgical; with rotator cuff repair).

And, NCCI clarifies that you [...]