Primary Care Coding Alert

Question: How should I code for a joint aspiration injection of lidocaine? Should I bill for the injection as well as the drug?

Georgia Subscriber  Answer: For the injection, you should report 20600* (Arthrocentesis, aspiration and/or injection; small joint or bursa [e.g., fingers, toes]), 20605* ( intermediate joint or bursa [e.g., temporomandibular, acromioclavicular, wrist, elbow or ankle, olecranon bursa]) or 20610* (... major joint or bursa [e.g., shoulder, hip, knee joint, subacromial bursa]). Normally, you would also report the medication with the appropriate HCPCS level-two supply code. The National Correct Coding Initiative, however, bundles lidocaine (J2000, Injection, lidocaine HCl, 50 cc) with injection codes 20526-20610. Therefore, many payers that follow the edits will not separately reimburse for lidocaine (J2000) when billed with a pain management injection, such as 20610.
 
Medicare bases this bundle on the dose specified in J2000. Because J2000 refers to 50 cc of lidocaine, Medicare covers the code only with ICD-9 codes that relate to cardiac arrhythmias, such as 427.9 (Cardiac dysrhythmia, unspecified) and emergencies.

For example, Georgia Medicares local policy for lidocaine 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. The policy concludes that when lidocaine is used as a local anesthetic, the payer will consider the drug part of the materials included in the procedure and will not separately reimburse it.

Regardless of payment, you should still report J2000. If you do not include the name of the drug with the injection procedure (20610), some insurers will deny the claim. This confuses some coders who believe that you should not list a nonreimbursable drug on the claim form. However, you should add the name and HCPCS code of the drug injected even if you do not expect reimbursement. Consequently, you should list J2000 on your injection claims, but expect Medicare to deny additional reimbursement for the drug by bundling the cost of the lidocaine into the injection payment. Answers to You Be the Coder and Reader Questions provided by Mary Falbo, MBA, CPC, president of Millennium Healthcare Consulting Inc., a healthcare consulting firm based in Landsdale, Pa.; Dalrona Harrison, RN, BS, CCS-P, CPC, approved American Academy of Professional Coders professional medical coding curriculum instructor and coding manager for Via Christi Medical Management in Wichita, Kan.; and Kent J. Moore, manager of Health Care Financing and Delivery Systems for the American Academy of Family Physicians in Leawood, Kan.