Pain Management Coding Alert

Published on Wed Dec 02, 2015 PDF

Question: Our physician used 2 mL of 0.75% Marcaine and 0.25mL of Kenalog for a trigger point injection. How do I bill this?

Vermont Subscriber

Answer: You should report one unit of medication for this injection. Code J3301 (Injection, triamcinolone acetonide, not otherwise specified, 10 mg) for triamcinolone (Kenalog) is reported per 10 mg. Kenalog comes in two strengths – Kenalog 10 is 10 mg per 1 mL and Kenalog 40 is 40 mg per 1 mL. An injection of 0.25 mL of Kenalog-10 would be 2.5 mg, whereas 0.25 mL of Kenalog-40 would be 10 mg.

Verify: You don’t specify which strength Kenalog your physician injected, but we’re assuming it was Kenalog-10 since you refer to J3301. Work with your providers to ensure that their documentation includes the specific drug that is administered as well as the total amount injected (mg, mcg, or Gm, not the volume).

Also: You do not bill separately for the Marcaine administration. Marcaine is a local anesthetic (similar to Lidociane) that providers may use to numb an area as part of a diagnostic or therapeutic injection. Most payers bundle the local anesthetic into the code for the injection and as such is not separately payable.