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Wiki Keloid injection, 96405 or 11900
- Thread starter JesseL
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jorzano55@gmail.com
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HI I am really confused. First where was the lesion and how many lesions were there. What is the diagnosis are they malignant. Usually keloids are not. What is 5fu in 30+ years of being I have never seen this before.
I really want to help but these codes are not correct in any situation and will end up causing you a denial and you need info if you send it how to correct the claim to get this paid. Please feel free to email my private email. Jorzano55@gmail.com
Good luck.
I really want to help but these codes are not correct in any situation and will end up causing you a denial and you need info if you send it how to correct the claim to get this paid. Please feel free to email my private email. Jorzano55@gmail.com
Good luck.
5fu is Fluorouracil.... I'm surprised if you've been in this field for 30+ year that you do not know this..
I've read from somewhere that you'd use 11900 for injection of steroid agents and 96405 for chemo agents like 5fu. I'm trying to figure out if this is true or if it's the correct code for a keloid injection of 5fu.. and if so what do I do if both kenalog(steroid) and 5fu(chemo) are injected to one same keloid on the skin.
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jorzano55@gmail.com
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WOW, I am surprised you asked for help and had only one response. I am surprised you had the nerve to be rude to me. I am a fellow coder and member of AAPC in good standing. I am an Officer in my Local Chapter and these forums are for helping each other and AAPC has rules about respecting each other. Your thread showed no respect to me or others who volunteer their time and efforts to help members like you. I took the time to look up these codes and read them and interpret them. I was trying to help you but I can assure you it won't happen again.
i'm sorry if that came out offensive, its a very commonly used drug in dermatology that i'm surprised you do not know of it. ALso, we did an injection to the lesion and you've asserted the codes I've bought up (11900 & 96405) "are not correct in any situation" which makes no sense to me because these are both injection codes for skin lesions. i rather find it strange you would make that statement and had some doubts in your responses. It's frustrating when you're asking for help just to get responses with strange questions. You asked "what is the diagnosis" when I clearly said keloid, you asked where was the lesion when these only occur on the skin, you asked how many lesions when I'm clearly talking about one lesion, you asked if its malignant and keloids are never malignant. These are questions you are asking me that shouldn't needed to be asked to answer my question which I felt was frustrating. I understand you tried to help, again I apologize. I try to be compliant as possible with coding and I do not want to miscode, over code or under code.
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mitchellde
True Blue
Jessie,
I see your confusion and I really have no definitive answer only an opinion. First off I do not feel you were being at all rude. 5fu is a drug that has been around for ages. It is a chemo agent and is used routinely for lesion injections. The problem here is the provided performed two types of treatment at the same time in the same lesion. This kind of muddies everything up. I think I would code only the chemo injection as it is the more intensive of the therapies as I suspect the other injection will bundle with the chemo injection and you risk the payer paying for the least expensive. I do no think you could get both to reimburse. Now havering said that... The new X modifiers might be interesting here, the XU could work for two procedures that are normally not performed together. I might try it just to see.
I see your confusion and I really have no definitive answer only an opinion. First off I do not feel you were being at all rude. 5fu is a drug that has been around for ages. It is a chemo agent and is used routinely for lesion injections. The problem here is the provided performed two types of treatment at the same time in the same lesion. This kind of muddies everything up. I think I would code only the chemo injection as it is the more intensive of the therapies as I suspect the other injection will bundle with the chemo injection and you risk the payer paying for the least expensive. I do no think you could get both to reimburse. Now havering said that... The new X modifiers might be interesting here, the XU could work for two procedures that are normally not performed together. I might try it just to see.
mitchellde
True Blue
Jessie was not being at all rude, and I am surprised you interpreted your response in that way. we are all here to learn. No one is trying to be rude or offensive. There was nothing disrespectful in her response, just a statement of surprise.
CatchTheWind
Guest
Jesse, I agree with Debra. I did not believe your response was rude.
Thanks ladies 
, one more thing.
The provider actually mixed the kenalog with the 5fu in one syringe i think so it's not like she did the injection with 2 separate syringes. would I still bill 96405 in this case?
Also, there was like only 0.1cc of the the 5fu and there's 50mg per a cc of 5fu, so that's like only 5mg of 5fu if my math is correct? and the 5fu drug code J9190 is 500mg.. do I still report J9190 with 1 unit even though its only 5mg injected, not any where near 500mg?
, one more thing.The provider actually mixed the kenalog with the 5fu in one syringe i think so it's not like she did the injection with 2 separate syringes. would I still bill 96405 in this case?
Also, there was like only 0.1cc of the the 5fu and there's 50mg per a cc of 5fu, so that's like only 5mg of 5fu if my math is correct? and the 5fu drug code J9190 is 500mg.. do I still report J9190 with 1 unit even though its only 5mg injected, not any where near 500mg?
apagano1
Contributor
how to bill kenalog and 5FU mixture.
my doctor is injecting a keloid with kenalog J3301, mixed with 5FU. Can someone please tell me how I would bill for both meds? It's a mixture, I'm using CPT 96372 injection. am I billing/listing both meds separately?
my doctor is injecting a keloid with kenalog J3301, mixed with 5FU. Can someone please tell me how I would bill for both meds? It's a mixture, I'm using CPT 96372 injection. am I billing/listing both meds separately?
CatchTheWind
Guest
I just noticed that no one ever replied to Jesse when she asked the same question. Sorry, Jesse!
So we have two cases in which the provider is mixing Kenalog and FU-5, but no clear guidelines about how to bill this.
My guess - and it's only a guess - is that you would use only one injection code, but both J codes. As Debra suggested, I would use the 96405 since that's the more complex code.
apagano1: 96372 is only used for a sub-q or intramuscular non-chemotherapy injections. Intralesional injection codes are 11900 for non-chemo (ie: kenalog) or 96405 for chemo. (FU-5 is a chemo agent.)
So we have two cases in which the provider is mixing Kenalog and FU-5, but no clear guidelines about how to bill this.
My guess - and it's only a guess - is that you would use only one injection code, but both J codes. As Debra suggested, I would use the 96405 since that's the more complex code.
apagano1: 96372 is only used for a sub-q or intramuscular non-chemotherapy injections. Intralesional injection codes are 11900 for non-chemo (ie: kenalog) or 96405 for chemo. (FU-5 is a chemo agent.)
CatchTheWind
Guest
I would like to revisit this issue, as I am having second thoughts about it:
Although 5FU is a chemotherapy agent, when we mix it with Kenalog to inject into a scar, it is not being used for its chemotherapy properties, but for its anti-fibrotic properties. Given that, I'm thinking that perhaps 11900 is a more accurate description of the service being performed.
I guess there is no definitive answer, but am starting to feel more comfortable coding this as 11900 + J3301 + J9190. We are going to start doing this way and see what happens.
Although 5FU is a chemotherapy agent, when we mix it with Kenalog to inject into a scar, it is not being used for its chemotherapy properties, but for its anti-fibrotic properties. Given that, I'm thinking that perhaps 11900 is a more accurate description of the service being performed.
I guess there is no definitive answer, but am starting to feel more comfortable coding this as 11900 + J3301 + J9190. We are going to start doing this way and see what happens.
I forgot where I read from but I had the impression that the code depends on the agent being injected to the lesions (11900 for steroids & 96405 for chemo agents)
CatchTheWind
Guest
Yes, that's absolutely true. Where my thought process was going is that since we have a conflict between the two injection codes (since we are using two types of agents), since the chemotherapy agent isn't even really being used as chemotherapy here, we should just go with the other code.
Any time we inject 5-FU alone (even into a scar) we would use 96405. Sorry, maybe I was being too vague!
Any time we inject 5-FU alone (even into a scar) we would use 96405. Sorry, maybe I was being too vague!