Pediatric Coding Alert

Don't let J2000 deletion stand in the way of proper reimbursement

Have your lidocaine code searches turned up fruitless? Stop looking: Payers include lidocaine in 90788.

HCPCS Codes 2004 deleted J2000 (Injection, lidocaine HCl, 50 cc), which many pediatric practices reported when administering Rocephin injections. Rocephin is an antibiotic that causes pain on injection. Pediatricians sometimes use lidocaine to minimize the pain.

So, when a child needs a Rocephin injection for otitis media (381-382) or to prevent hospitalization for pneumonia (480-487), many pediatricians dilute the antibiotic with lidocaine to reduce the patient's pain. If your practice also follows Rocephin's manufacturer guidelines and dilutes the drug with lidocaine, you may have billed for both the antibiotic and the anesthetic. But HCPCS 2004 wiped out this option.

To find out how this change will affect your billing, experts answer your top questions:

1. How Should I Code an Anesthetized Rocephin Shot?

Your claims for Rocephin injections with lidocaine should now contain three codes rather than four. 

You will still bill 90788 (Intramuscular injection of antibiotic [specify]) for the intramuscular antibiotic injection. For the evaluation, history and medical decision-making that lead your pediatrician to administer the injection, you will also report an office visit (99201-99215, Office or other outpatient visit for the evaluation and management of a new or established patient ...). But, your supply coding will change.

Before HCPCS deleted J2000, you may have used two supply codes when billing for Rocephin injections containing lidocaine. For the Rocephin, you should have reported J0696 (Injection, ceftriaxone sodium, per 250 mg) per 250 mg. You also may have coded the lidocaine with J2000. Now, you should bill only J0696 for the antibiotic.

2. Why Did HCPCS Delete J2000?

The new bundle shouldn't shock you. Code J2000's elimination follows CPT, ICD-9 and CMS guidelines. CPT includes "local infiltration, metacarpal/metatarsal/ digital block or topical anesthesia" as part of the surgical package definition. So, with Rocephin injections, the procedure includes the anesthetic, says Susan Callaway, CPC, CCS-P, an independent coding consultant and educator in North Augusta, S.C. "I have always contended that you shouldn't report J2000 for anesthetic use," she says.

You face an additional coding dilemma when you determine the diagnosis to use for lidocaine with a Rocephin injection. No ICD-9 code justifies the anesthetic's medical necessity, Callaway says. You would use the child's illness, such as pneumonia (486), for the Rocephin. But lidocaine doesn't treat pneumonia. Instead, the anesthetic numbs the pain the injection causes.

Don't overlook: Medicare never intended J2000 for anesthetic use. The code is for 50 ccs, Callaway says. This increment is much larger than the typical 250-mg-to-2-g lidocaine dose staff use to dilute a child's Rocephin injection. "You were supposed to use J2000 for cardiac arrhythmia (427.9) treatment," she says.

3. Will Insurers Still Pay for Lidocaine?

Most payers adapted their fee schedules to reflect J2000's deletion. For instance, Blue Cross Blue Shield of Arkansas, which covers Oklahoma and New Mexico, doesn't list a 2004 allowance for the code.

Cost: The deletion shouldn't hurt your reimbursement. Most insurers already bundle lidocaine into the injection. "Pretty much all the major companies stopped paying for J2000 as an anesthetic long ago," Callaway says.

"Even if the deletion cut a paying code from your superbill, the bundle won't have a big monetary impact," says Judy Richardson, MSA, RN, CCS-P, senior consultant with Hill & Associates in Wilmington, N.C. "The 2003 reimbursement from various insurers, including Tricare, which bases their allowable charges on Medicare, ranged from $1.34 to $3.76."