Primary Care Coding Alert

Get the inside scoop on J2000 deletion

Have your lidocaine code searches turned up fruitless? Stop looking: The manual no longer contains J2000.

HCPCS 2004 deletes J2000 (Injection, lidocaine HCl, 50 cc), which many family practices report when administering Rocephin injections to children. Rocephin, which is a type of antiobiotic with the generic name ceftriaxone sodium, is a very painful injection due to the amount of liquid injected into the muscle, says Cathy Rogers- Medicare Part B carrier, stipulates, "Removal Kowalski, manager and billing coordinator for the solo-practice of family physician Gregory A. Kowalski, DO, PA, in Las Cruces, N.M. The lidocaine takes away the longer-term pain of the fluid expanding inside the muscle.

So, when a child needs a Rocephin injection for otitis media (381-382) or to prevent hospitalization for pneumonia (480-487), antibiotic with lidocaine to reduce the patient's pain.

If your practice also follows manufacturer's lidocaine, you may have billed for both the antibiotic and the anesthetic. But HCPCS 2004 wipes out this option.

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

Your claims for Rocephin injections with lidocaine should now contain three procedure 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 FP 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.

Old way: 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.

New way: You should bill only J0696 for the antibiotic. Consider J2000 a component of the medical procedure (90788).

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 have 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 upper respiratory infection (URI), for the Rocephin. But lidocaine doesn't treat a URI, such as 465.9. 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.

But you may still receive reimbursement for lidocaine as an anesthetic. The 2003 fee schedule is effective through March 31, Callaway says. So, insurers may pay for J2000 even though the 2004 fee schedule doesn't contain 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 cuts a paying code from your superbill, the bundle "The 2003 reimbursement from various insurers, including Tricare, which bases their allowable charges on Medicare, ranged from $1.34 to $3.76," Rogers-Kowalski says.