Otolaryngology Coding Alert

Question: May I bill for Kenalog in addition to 11900? If so, how do I calculate the fee? I have the vial's cost, but the procedure required drawing only one-half of the vial.

Minnesota Subscriber

Answer: In the office (place-of-service code 11), you may report the medication and the injection (11900, Injection, intralesional; up to and including 7 lesions).

When your ENT office purchases the Kenalog, you would code the medication with J3301 (Injection, triamcinolone acetonide, per 10 mg). To bill for half of a 10-mg vial (Kenalog-10), use 0.5 units, which equates to billing for 5 mg of Kenalog. If your staff drew half of a Kenalog-40 vial, use J3301 x 2 (for 20 mg).

If your ENT provides the injection in a facility, the facility bills for the Kenalog. In these cases, the outpatient hospital (POS 22) or ambulatory surgical center (POS 24) has purchased the medication and therefore charges for the supply.