Pain Management Coding Alert

Question: Dictation from an encounter states that the physician used 2 mL of 0.75% Marcaine and 0.25mL of Kenalog for a trigger point injection. I know I shouldn’t code the Marcaine, but would J3301 be billed at 1 unit?

Minnesota Subscriber

Answer: Yes, you should report one unit for this situation. Code J3301 (Injection, triamcinolone acetonide, not otherwise specified, 10 mg) for triamcinolone (Kenalog) is reported per 10 mg. Kenalog comes in two strengths – Kenalog 10 is 10 mg per 1 mL and Kenalog 40 is 40 mg per 1 mL

An injection of 0.25 mL of Kenalog-10 would be 2.5 mg, whereas 0.25 mL of Kenalog-40 would be 10 mg.

Best practice: You don’t specify which strength Kenalog your physician injected, but we’re assuming it was Kenalog-10 since you refer to J3301. Work with your providers to ensure that their documentation includes the specific drug that is administered as well as the total amount injected (mg, mcg, or Gm, not the volume).

You are also correct in not billing separately for the Marcaine administration. Similar to Lidocaine, Marcaine is a local anesthetic that is used in part to numb an area as part of a diagnostic/therapeutic injection. The local anesthetic is bundled by most payers into the code for the injection and as such is not separately payable.