Orthopedic Coding Alert

Question: Another coder told me that as of Jan. 1, Medicare will only accept code J7318 for Synvisc injections, but our insurer denied this code. How should we report this service?


Texas Subscriber
Answer: You should continue to use the same codes that you-ve used in the past--J7317 (Sodium hyaluronate, per 20 to 25 mg dose for intra-articular injection) or J7320 (Hylan G-F 20, 16 mg, for intra-articular injection).

Although many carriers alerted physicians to the new code J7318 (Hyaluronan [sodium hyaluronate] or derivative, intra-articular injection, 1 mg), CMS decided to delete J7318 before Jan. 1. However, not all physicians were aware of the deletion and started using it on Jan. 1 as instructed. If you reported J7318 and the insurer denied your claims, you should refile the claim using the
accurate codes.

CMS announced the change in a Nov. 8, 2005, transmittal, which stated, -CMS has decided to further evaluate several unique issues associated with the classification of sodium hyaluronan products. Therefore, CMS will not implement its decision to establish a single new code--J7318 -Hyaluronan (Sodium Hyaluronate) or Derivative, Intra-Articular Injection, 1mg---to describe all sodium hyaluronate/hyaluronans. The codes used in 2005 will still apply.- To read the full transmittal, visit the CMS Web site www.cms.hhs.gov/transmittals/downloads/R749CP.pdf.