Urology Coding Alert

Question: Is there a code we should bill for subcutaneous lidocaine or lidocaine with epinephrine during an office procedure? Some of the physicians in our group are asking for a code on the superbill, while others feel we should count it in the procedure code. Should we bill separately for the lidocaine injections?

Pennsylvania Subscriber

Answer: The physicians in your group who state that the lidocaine injections should be counted as part of the procedure are partially correct. Medicare specifies that local anesthetic use is "an inherent surgical procedure component, and is not separately billable." Medicare includes all "surgical anesthesia" administered by the operating surgeon as part of the surgical package and not a payable service. There are many private, non-Medicare or commercial insurance carriers, however, that will pay for anesthesia blocks but not for topical or local anesthesia. For these carriers, you can separately bill for any anesthesia blocks administered by the operating surgeon.

The only code for lidocaine is J2001 (Injection, lidocaine HCl for intravenous infusion, 10 mg). In 2004, CMS deleted J2000 (Injection, lidocaine HCl, 50 cc), which many practices were using to bill for injected lidocaine. When coding for Medicare and other carriers, you cannot consider J2001 the same way, however, because the code descriptor specifies that the physician must administer the lidocaine via an IV infusion to use this code. In fact, the Correct Coding Initiative (CCI) bundles J2001 with many minor procedure codes to specifically prevent you from reporting it with an injection code.

Alternative: For non-Medicare carriers, consider using HCPCS code S0020 (Injection, bupivacaine HCl, 30 ml, use this code for Marcaine, Sensorcaine) for billing the drug itself when your physician administers it in the office setting.

-- Answers to Reader Questions and You Be the Coder contributed by Michael A. Ferragamo, MD, FACS, clinical assistant professor of urology, State University of New York, Stony Brook; and Morgan Hause, CCS, CCS-P, privacy and compliance officer for Urology of Indiana LLC, a 31-urologist, two-urogynecologist practice in Indianapolis.