Wiki Billing J Codes During Post-op Period

[Diana2032]

Hello,

I was wondering if anyone knows if J codes such as J1030 (Depo-Medrol), J3301 (Kenalog), etc are billable during the post-op period.

I know that Medicare does not allow payment of postoperative complications and pain management during the post-op period unless the patient's go back to the OR table. But let's say the patient undergoes a RT knee menisectomy and 2 weeks later the patient comes back for follow-up visit reporting RT knee pain, the provider gives an injection of Kenalog. Should I bill 99024 in addition to J3301?

Currently Medicare states the following as being included under the "Components of Global Surgical Package":

* Post surgical pain management - by the surgeon
* Supplies - Except for those identified as exclusions

There is no list of supplies identified as "exclusions" available on CMS manuals. Will drugs injected for pain management be separately billable?

Can anyone provide an official guideline on this? From any MAC carrier. I need to be able to provide supportive documentation to my physician. In my mind J codes are billable during post-op period when related to a complication.

Thank you.

 

[Orthocoderpgu]

Insurance does not understand

You are correct. Medicare won't pay for any post-op complication unless the patient returns to the OR.

For insurance providers who do not follow CMS on this, you can bill the injection with the medication.

The 20610 & the J codes are "packages" meaning that insurance should process the same on BOTH procedure codes, however they generally don't do that in actuality. I see where they deny the 20610 code but pay the J code!

Go figure.