Orthopedic Coding Alert
Expect Denials for Claims Including G0351
New drug admin code follows 90780-90784 example, coding experts say Orthopedic practices reporting the new G codes for drug administration may be in for a disappointment now that payers have begun to implement version 11.2 of the National Correct Coding Initiative (NCCI), which took effect July 1. NCCI Bundles G0351 Into Musculoskeletal Codes The G codes replaced therapeutic or diagnostic infusion codes 90780-90784, according to the Nov. 15, 2004, Federal Register. Previous versions of NCCI bundled 90780-90784 into many musculoskeletal codes, so doing the same with the new G codes doesn't surprise many experts.
The latest edition of NCCI declared injection code G0351 (Therapeutic or diagnostic injection [specify substance or drug]; subcutaneous or intramuscular) a component of 4,531 codes, including nearly every musculoskeletal code.
"Orthopedic coders are more likely to perform tendon injections (20550-20551), trigger point injections (20552-20553) or joint injections (20600-20610) than these muscle injections," says Heather Corcoran, coding manager at CGH billing in Louisville, Ky. "Therefore, this shouldn't affect reimbursement for most orthopedic practices."
Even so, Corcoran says, orthopedic coders should be on the lookout for instances when G0351 describes the physician's procedure better than any other code. "In that case, make sure you are aware of all the bundling issues," she says.
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