Orthopedic Coding Alert

Question: Is there any way that Medicare will reimburse us for a shoulder injection using Synvisc?

Minnesota Subscriber

Answer: No. Because the U.S. Food and Drug Administration approved Synvisc (J7320, Hylan G-F 20, 16 mg, for intra-articular injection) only for patients with osteoarthritis of the knee (715.16, 715.26, 715.36 and 715.96), Medicare will not cover its use for any other diagnoses or conditions.

Some private payers reimburse for the medication when Synvisc is injected into the shoulder, but most will not pay for the administration (20610*, Arthrocentesis, aspiration and/or injection; major joint or bursa [e.g., shoulder, hip, knee joint, subacromial bursa]).

Don't assume, however, that you cannot report an outpatient consultation code when the ED physician calls your orthopedist to evaluate a patient. Each encounter must be evaluated individually.