Orthopedic Coding Alert

Editors Note: These questions refer to an article on the new HCPCS codes for Hyalgan, J7315 (sodium hyaluronate, 20 mg, for intra-articular injection) and for SynVisc, J7320 (Hylan G-F 20, 16 mg, for intra-articular injection), which appeared in the January issue of ORC (page 7).

Joyce Parreira, Billing Supervisor for Lancy Allyn & Associates, Hanford, CA, posed the following questions:

Question 1: My December 98 issue of the NHIC Medicare Bulletin says the code for both is J3490 (unclassified drugs). So, should I continue to use the unclassified code or start using the new codes?

Answer 1: The new codes went into effect for Medicare claims on January 1, 1999, so the information you received from the NHIC publication was published before that date. But, because coders often learn changes before payers, check with your coders to find out their requirements.

Question 2: I have noticed on our EOBs recently that payers have changed our J9999 (not otherwise classified, antineoplastic drug) to J3490. We had been given instructions from the drug representative to use J9999, which now appears to be an inaccurate description of this service.

Answer 2: Our sources tell us that J9999 is an antineoplastic drug that is specific to chemotherapy and, as such, should never be used for Hyalgan or SynVisc. Again, instead of automatically coding J3490, talk with your payers, particularly your health maintenance organizations (HMO), as some sources report various HMOs have not yet assigned a specific code and fee for these injections.