Eli's Rehab Report

Question: We have been reporting J2690 (Injection, procainamide HCl, up to 1g) for procaine injections, but a billing consultant recently told us that we can only report this code when injecting procainamide for cardiac patients, not for pain management. Is this accurate?

Oklahoma Subscriber

Answer: Chances are that your physiatrist is injecting procaine HCl instead of procainamide HCl. HCPCS code J2690 describes the medication that cardiologists administer to patients with arrhythmias and other conditions. Even if your physiatrist is injecting procainamide HCl, however, your insurer probably won't pay for it.

Most payers do not reimburse practices for pain management-related procaine injections. Although most carriers do not publish specific policies regarding procaine, insurers usually lump procaine with the other "caine" drugs, such as lidocaine and marcaine.

Medicare bars practices from collecting reimbursement for lidocaine injections when used for any conditions besides cardiac diagnoses, and CCI bundles J2000 (Injection, lidocaine HCl, 50 cc) into the injection codes 20526-20610. In addition, many carriers maintain policies prohibiting practices from billing J2000 for pain management injections.

For example, Georgia Medicare's lidocaine policy states, "The dosage indicated by the code description is specific to the treatment of cardiac arrhythmias and emergencies only. The billing of J2000 is not appropriate for the 1-2 cc usually required for a local anesthetic. ... When used as a local anesthetic, lidocaine will be considered part of the materials included in the procedure and will not be separately reimbursable."

Ask your carrier whether it maintains a similar policy for procaine before submitting your bill for this drug. If your insurer prohibits you from reporting J2690 for the injection, you should report the applicable injection code only, for example, 20500, 20600, etc.

You Be the Coder and Reader Questions were reviewed by Laureen Jandroep, OTR, CPC, CCS-P, CPC-H, CCS, director and senior instructor for the CRN Institute, an online coding certification training center.