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Orthopedic Coding Alert

Reader Question:

Medicare May Deny Procaine Injections

Question: We have been reporting J2690 (Injection, procainamide HCl, up to 1g) for procaine injections, but a billing consultant recently told us that we can only report this code when injecting procainamide for cardiac patients, not for pain management. Is this accurate? Oklahoma Subscriber Answer: Chances are your orthopedist is probably injecting procaine HCl instead of procainamide HCl. HCPCS code J2690 describes the medication that cardiologists administer to patients with arrhythmias and other conditions. Most payers do not reimburse practices for pain management-related procaine injections. Although most carriers do not publish specific policies regarding procaine, insurers usually lump procaine with the other "caine" drugs, such as lidocaine, marcaine, etc.

Medicare bars practices from collecting reimbursement for lidocaine injections when used for any conditions other than cardiac diagnoses, and the National Correct Coding Initiative (NCCI) bundles J2000 (Injection, lidocaine HCl, 50 cc) into injection codes 20526-20610. Many carriers maintain written policies prohibiting practices from billing J2000 for pain management. For example, Georgia Medicare's lidocaine policy 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 ... When used as a local anesthetic, lidocaine will be considered part of the materials included in the procedure and will not be separately reimbursable."

Ask your carrier whether it maintains a similar policy for procaine before submitting your bill for this drug. If your insurer prohibits you from reporting J2690 for the injection, you should report the applicable injection code only (for example, 20500, 20600, etc.).


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