Wiki LIDOCAINE PAIN MANAGEMENT BLOCKS

[MLITE2113]

Hello!
I am having a disagreement with a coworker regarding Lidocaine HCPCS code and Whether or not to Code with PM Spinal Block injections on a Outpatient Hospital Claim.
The lidocaine is mixed with the steroid and injected into the Epidural Space. Procedure is a Lumbar Facet Block - Should the lidocaine be billed along with the steroid? What HCPCS code would you use for the Lidocaine? Patient is under MAC sedation. (I understand MAC isn't medically necessary but, it was used)
Now another scenario is local anesthetic was used prior to the actual injection as an anesthetic and also mixed with the steroid. Procedure Lumbar Facet Block. Is the Lidocaine coded separately in this situation? What HCPCS code for the Lidocaine?
Again this is only for Outpatient Hospital coding which I've recently found that CMS doesn't follow AMA guidelines on Bilateral Add on Procedures so now I'm questioning everything. Our hospital follows CMS for Pain Management injections mostly.
Any links are appreciated as well

Thanks in Advance!!

 

[thomas7331]

I take it you're coding for the facility, correct? The facility can (and should) bill for the supplies and drugs associated with the procedure. It unusual to 'code' the drugs - in the facilities where I've worked, drugs and supplies are hard-coded into the hospital charge master and automatically populate onto the claim when the items are scanned to the patient's account by the nursing staff during the course of care, and coders aren't responsible for assigning those. The coder's role is usually just to code at the procedure level based on physician documentation, not to code every single item associated with the care.

Low-cost drugs such as lidocaine and steroids won't usually be itemized with a HCPCS code on a UB claim, and probably would just be a component of the amount charged under revenue code 250. That could depend on the payer though. Anyway, in most cases routine drugs supplies associated with a procedure aren't going to factor in reimbursement because payment is made at an APC or case rate that is inclusive to those charges. But some payers do reimburse hospitals at a percentage of charge, so you do want to be sure that your charges reflect all costs that were incurred during the encounter.

If you're having a disagreement with a co-worker about the right way to code this, it's something you need to take to your management and get their input on. Hospital coding policies are very individualized because there are so many different factors involved in how the information is populated onto the UB claim and the coding procedures need to take into account how the entire system is working together in generating the claim.

 

[MLITE2113]

I take it you're coding for the facility, correct? The facility can (and should) bill for the supplies and drugs associated with the procedure. It unusual to 'code' the drugs - in the facilities where I've worked, drugs and supplies are hard-coded into the hospital charge master and automatically populate onto the claim when the items are scanned to the patient's account by the nursing staff during the course of care, and coders aren't responsible for assigning those. The coder's role is usually just to code at the procedure level based on physician documentation, not to code every single item associated with the care.

Low-cost drugs such as lidocaine and steroids won't usually be itemized with a HCPCS code on a UB claim, and probably would just be a component of the amount charged under revenue code 250. That could depend on the payer though. Anyway, in most cases routine drugs supplies associated with a procedure aren't going to factor in reimbursement because payment is made at an APC or case rate that is inclusive to those charges. But some payers do reimburse hospitals at a percentage of charge, so you do want to be sure that your charges reflect all costs that were incurred during the encounter.

If you're having a disagreement with a co-worker about the right way to code this, it's something you need to take to your management and get their input on. Hospital coding policies are very individualized because there are so many different factors involved in how the information is populated onto the UB claim and the coding procedures need to take into account how the entire system is working together in generating the claim.

I like the response. We have an off campus hospital and no pharmacy department to add the drug charges on the claim so they get coded by the coding department. At our on campus location the pharmacy does add the charges and Lidocaine does fall under the 250 rev code. Now I understand and may have a rebuttle for my coworker but, one more thing since the coding department is coding the drugs would you code J2001 or J3490 for lidocaine mixed with steroids or local injected IM prior to the injection? Coworker says J2001 I say no since it's not being pushed through an IV. Am I wrong?

Sincerely appreciate your response! Thank you!

 

[thomas7331]

I like the response. We have an off campus hospital and no pharmacy department to add the drug charges on the claim so they get coded by the coding department. At our on campus location the pharmacy does add the charges and Lidocaine does fall under the 250 rev code. Now I understand and may have a rebuttle for my coworker but, one more thing since the coding department is coding the drugs would you code J2001 or J3490 for lidocaine mixed with steroids or local injected IM prior to the injection? Coworker says J2001 I say no since it's not being pushed through an IV. Am I wrong?

Sincerely appreciate your response! Thank you!

You're correct, J2001 is only for a lidocaine IV infusion which is not the case here.

Not sure why your hospital would be having coders adding drug charges, this just doesn't make sense. I think if you start trying to code this you're going to have billing headaches and be dealing with possible denials. These drugs, in the majority of cases, aren't likely to affect reimbursement at all, and the price of lidocaine is so low that you’re going to cost your hospital more by trying to include it. If you start adding codes, then it could get into trouble with NDC numbers and payers asking for different revenue codes, etc. with very little upside in the way of additional revenue. Honestly I would sooner recommend just leaving the charges off rather than trying to submit a code for this if you’re not set up for it.

If there's a way you can find out what your main campus uses and just post those charges, that's going to be a lot easier. Most likely these drugs are already set up in the charge master and built to populate correctly on the claims according to payer requirements. If you can just find the correct way to add them to the accounts when needed, then you won't have to worry about all of the other details.