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 dexamethasone acetate (J1094, Injection, dexamethasone acetate, 1 mg) or dexamethasone sodium phosphate (J1100, Injection, dexamethasone sodium phosphate, 1mg). You might need to change the dexamethasone code on your claim.

In addition, J2010 (Injection, lincomycin hcl, up to 300 mg) is for the antibiotic Lincomycin, not the local anesthetic lidocaine. The only HCPCS code for lidocaine is J2001 (Injection, lidocaine HCl for intravenous infusion, 10 mg), which is for IV administration only. As noted above, consistent with CPT®, most payers don't separately reimburse for the local anesthetic used in injections. Whether you transposed the digits "0" and "1" on your claim and reported Lincomycin by mistake or whether you reported Lidocaine, the payer probably won't reimburse.

If the claim is for a Medicare patient, remember that Medicare doesn't accept any of the HCPCS "S" codes such as S0020. If you want to bill bupivacaine to Medicare, you would need to submit J3490 (Unclassified drugs). However, most Medicare contractors do not pay separately for bupivacaine (Marcaine) unless it is in an implanted infusion pump.