Dermatology Coding Alert
Untangle These Lidocaine Bundles
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Question: I'm fairly new to coding, and I was told that I should submit J2001 for lidocaine injections used with other procedures, but our claims keep coming back as denials. What am I doing wrong? Answer: In July 2004, the National Correct Coding Initiative bundled J2001 (Injection, lidocaine HCl for intravenous infusion, 10 mg) into many common dermatologic services, eliminating the possibility of separate reimbursement for this injection code.
Vermont Subscriber
With the bundling of J2001, lidocaine injection became a component code to many comprehensive codes often used in dermatology, including biopsy (11100), shaving of epidermal or dermal lesions (11300-11308), lesion destruction (17000-17286), and Mohs micrographic surgery (17304-17307).
Upside: All of the above procedures have a status indicator of 1, which means they can be unbundled using modifier 59 (Distinct procedural service) when applicable. Warning: Don't forget the modifier 59 guidelines, or you can forget separate reimbursement.
When you try to claim lidocaine injection as a distinct service, the procedural codes should fit into one of five situations: different sessions or encounters, different sites/organ systems, separate incisions/excisions, separate lesions, or separate injuries. Some carriers will also look for a different diagnosis code to ensure that the procedure is separate and distinct.
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