Neurology & Pain Management Coding Alert

Question: Our provider sometimes administers sodium bicarbonate to help lessen the pain of injections. Does HCPCS include a code for this? Louisiana Subscriber Answer: Appendix 1 of HCPCS includes sodium bicarbonate in the "unclassified drugs" table. It lists an 8.4 percent concentration with a per-unit quantity of 50 ml by IV administration. Because it is an unclassified drug, you would report J3490 (Unclassified drugs). Caution: Before you automatically report this, however, look at what your physician actually did. Physicians primarily administer a sodium bicarbonate IV to correct a patient's blood pH in a facility setting, which correlates with the amount the code represents. In an office setting, a physician might use sodium bicarbonate to increase the pH of an injectable medication and potentially eliminate some of the irritation when injecting a local anesthetic like Lidocaine. Most neurologists would not administer 50 ml or use IV administration in this type of situation. Because of this, submitting an extra code for the sodium bicarbonate isn't necessarily appropriate. Your best option is to report the actual medication such as Lidocaine (J2001, Injection, lidocaine HCl for intravenous infusion, 10 mg).