Primary Care Coding Alert

Question: We've had increasing problems billing and being paid for the medications we use for trigger point and nerve block injections. We bill J1094 for Dexamethasone 4 mg, S0020 for Marcaine 0.5% and J2010 for Lidocaine 2%. We never get paid for the Marcaine and rarely get paid for the Dexamethasone. Are there other drugs we should be using? Or are we using the correct drugs with the wrong codes? What should I change when we resubmit? North Carolina Subscriber Answer: Physicians typically use Marcaine as an anesthetic for the procedure. If you look in your CPT® book under "CPT® surgical package definition," it outlines that, "local infiltration, metacarpal/metatarsal/digital block or topical anesthesia" is included in the CPT® surgical code. Therefore, you shouldn't report S0020 (Injection, bupivacaine hydrochloride, 30 ml) when your provider uses the Marcaine as an anesthetic prior to the injection. Second, check whether your physician is injecting [...]