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.

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."

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 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 cannot report several shoulder arthroscopy codes together. The new version bundles arthroscopy codes 29807-29821, 29823 and 29825-29826 into 29806 (Arthroscopy, shoulder, surgical; capsulorrhaphy). Therefore, if you perform shoulder arthroscopy and repair a SLAPlesion, you should report 29807 (... repair of SLAP lesion) only. If you report both 29806 and 29807, your carrier will only reimburse you for 29806 and will bundle the SLAPrepair into the shoulder arthroscopy code.

NCCI follows a similar format with the knee and ankle codes, bundling knee codes 27570, 29870, 29874-29875 and 29884 into 29873 (Arthroscopy, knee, surgical; with lateral release).

Ankle arthroscopy code 29899 (Arthroscopy, ankle [tibiotalar and fibulotalar joints], surgical; with ankle arthrodesis) is now the comprehensive code that includes component codes 27860 (Manipulation of ankle under general anesthesia [includes application of traction or other fixation apparatus]) and 29897 (Arthroscopy, ankle [tibiotalar and fibulotalar joints], surgical; debridement, limited).

The NCCI also now bundles the physical therapy reevaluation code 97002 into physical therapy procedure codes 97532 (Development of cognitive skills to improve attention, memory, problem solving [includes compensatory training], direct [one-on-one] patient contact by the provider, each 15 minutes) and 97533 (Sensory integrative techniques to enhance sensory processing and promote adaptive responses to environmental demands, direct [one-on-one] patient contact by the provider, each 15 minutes). Because the NCCI already bundles 97002 into almost all of the other therapeutic procedure codes, this edit won't come as a shock to most therapists, says Amy Nasser, PT, a practicing physical therapist in Kansas City, Mo. "Unless you perform the re-evaluation separately from the therapeutic procedure, most insurers won't pay."

Good news: Because all of the new code bundles listed above feature a "1" indicator, you can append a modifier (such as modifier -59, Distinct procedural service) to separate the services.

Remember, you should only use a modifier to separate an NCCI bundle if the physician performs the procedures during separate sessions or for different reasons, and if the orthopedist deems both services medically necessary.

Note: Visit www.cms.hhs.gov/physicians/cciedits/default.asp for links to documents that explain the edits, including the NCCI Policy Manual for Part B Medicare Carriers, the Medicare Carriers Manual, and an NCCI Question-and-Answer page.