Advanced Search

Anesthesia Coding Alert

Reader Questions:

Payer Determines Marcaine Code

Published on Tue Mar 11, 2008

Question: Our payers have started denying J codes for Marcaine (bupivacaine). What are we doing wrong?New Mexico SubscriberAnswer: If your provider uses Marcaine as a local anesthetic for an injection procedure and/or to lessen the patient's discomfort from another medication, most payers (including Medicare) will not separately reimburse the Marcaine. But if your provider uses Marcaine as one of the medications to refill an implanted infusion pump, some payers might process payment for that.If you do report the drug, payers usually require J3490 (Unclassified drugs); other payers (such as some Blue Cross) require S0020 (Injection, bupivacaine HCl, 30 ml) instead.Another tip: Check for your individual payer's requirements when filing J3490; many payers require specific information in box 19 or the electronic equivalent before processing the line item. Some examples include drug name, total dosage, administration route, or even the drug's NDC number.
You’ve reached your limit of free articles. Already a subscriber? Log in.
Not a subscriber? Subscribe today to continue reading this article. Plus, you’ll get:
  • Simple explanations of current healthcare regulations and payer programs
  • Real-world reporting scenarios solved by our expert coders
  • Industry news, such as MAC and RAC activities, the OIG Work Plan, and CERT reports
  • Instant access to every article ever published in your eNewsletter
  • 6 annual AAPC-approved CEUs*
  • The latest updates for CPT®, ICD-10-CM, HCPCS Level II, NCCI edits, modifiers, compliance, technology, practice management, and more
*CEUs available with select eNewsletters.

Other Articles in this issue of

Anesthesia Coding Alert

View All