Pediatric Coding Alert

If you were billing J2001 with your injections, the latest edits will get your attention

The National Correct Coding Initiative, version 10.2, went into effect on July 1, and while the edits shouldn't be too burdensome for pediatric practices, you'll need to keep an eye on some new lidocaine bundles if you want to avoid a flood of denials.

The biggest and best news from the latest NCCI edits is that primary-care providers "don't have to worry about anything being bundled into their office visits" because 10.2 contains no changes to the E/M codes, says Jean Acevedo, CPC, LHRM, senior consultant, Acevedo Consulting Inc.

But the lack of E/M edits doesn't mean your practice is off the version-10.2 hook. The latest edits reinforce the guidelines that you cannot report lidocaine used as local anesthesia for any procedures other than those used to treat cardiac arrhythmia. CMS tried to put a stop to practices reporting lidocaine with noncardiac service by deleting the popular J2000 (Injection, lidocaine HCl, 50 cc) in HCPCS 2004 (see story on page 58) and replacing it with the more specific code J2001 (Injection, lidocaine HCl for intravenous infusion, 10 mg).

NCCI 10.2 takes the lidocaine crackdown a step farther and bundles J2001 into hundreds of CPT codes. For example, if a pediatrician performs arthrocentesis, coders cannot report the supply of the drug separately, says Mary Falbo, MBA, CPC, president of Millennium Healthcare Solutions.

Remember: "The injection of a 'caine'while doing a joint injection is for pain control and shouldn't be billed separately," says Denise Paige, CPC, president of the American Academy of Professional Coders' Long Beach Chapter. "There are those who think that this never should have been billed separately in the first place, and after J2000 was deleted I think that further backs up that theory. I now only bill for the joint injection and the cortisone."

NCCI doesn't stop at injections: The new version of NCCI doesn't just bundle J2001 into injection codes. You will face denials if you report J2001 with most musculoskeletal codes, including several fracture care codes (such as 25611, 27538, and many others), biopsy codes (including 24065) and bone excision codes (such as 28124).