Orthopedic Coding Alert

Question: I have recently read a lot of conflicting advice regarding when I can report J3490 for Marcaine. Would you clarify this?

North Carolina Subscriber

Answer: If your orthopedist injects Marcaine as a local anesthetic during a surgical procedure, such as a trigger point injection (20552-20553, Injection[s]; single or multiple trigger point[s] ....), you usually can't recoup reimbursement for the drug.
 
Most payers bundle the Marcaine into the reimbursement for the procedure, based on CPT's surgical package definition, which includes "local infiltration, metacarpal/metatarsal/digital block or topical anesthesia." Some carriers may suggest that you report J3490 (Unclassified drugs) or S0020 (Injection, bupivicaine HCl, 30 ml) for tracking purposes.
 
You can separately report therapeutic injectable supplies, such as steroids. If, for instance, your physician injects a wrist tendon (20551, Injection[s]; single tendon origin/insertion) with a corticosteroid such as Depo-Medrol (J1020, Injection, methylprednisolone acetate, 20 mg; J1030, Injection, methylprednisolone acetate, 40 mg; J1040, Injection, methylprednisolone acetate, 80 mg) or triamcinolone (J3302, Injection, triamcinolone diacetate, per 5 mg), you should bill for the procedure (20551) and the drug (J1020-J1040, J3302).