Primary Care Coding Alert

Get the inside scoop on J2000 deletion Have your lidocaine code searches turned up fruitless? Stop looking: The manual no longer contains J2000. HCPCS 2004 deletes J2000 (Injection, lidocaine HCl, 50 cc), which many family practices report when administering Rocephin injections to children. Rocephin, which is a type of antiobiotic with the generic name ceftriaxone sodium, is a very painful injection due to the amount of liquid injected into the muscle, says Cathy Rogers- Medicare Part B carrier, stipulates, "Removal Kowalski, manager and billing coordinator for the solo-practice of family physician Gregory A. Kowalski, DO, PA, in Las Cruces, N.M. The lidocaine takes away the longer-term pain of the fluid expanding inside the muscle. So, when a child needs a Rocephin injection for otitis media (381-382) or to prevent hospitalization for pneumonia (480-487), antibiotic with lidocaine to reduce the patient's pain.

If your practice also follows manufacturer's lidocaine, you may have billed for both the antibiotic and the anesthetic. But HCPCS 2004 wipes out this option. To find out how this change will affect your billing, experts answer your top questions: How Should I Code an Anesthetized Rocephin Shot? Your claims for Rocephin injections with lidocaine should now contain three procedure codes rather than four.

You will still bill 90788 (Intramuscular injection of antibiotic [specify]) for the intramuscular antibiotic injection. For the evaluation, history and medical decision-making that lead your FP to administer the injection, you will also report an office visit (99201-99215, Office or other outpatient visit for the evaluation and management of a new or established patient ...). But, your supply coding will change. Old way: Before HCPCS deleted J2000, you may have used two supply codes when billing for Rocephin injections containing lidocaine. For the Rocephin, you should have reported J0696 (Injection, ceftriaxone sodium, per 250 mg) per 250 mg. You also may have coded the lidocaine with J2000. New way: You should bill only J0696 for the antibiotic. Consider J2000 a component of the medical procedure (90788). Why Did HCPCS Delete J2000? The new bundle shouldn't shock you. Code J2000's elimination follows CPT, ICD-9 and CMS guidelines. CPT includes "local infiltration, metacarpal/ metatarsal/digital block or topical anesthesia" as part of the surgical package definition. So, with Rocephin injections, the procedure includes the anesthetic, says Susan Callaway, CPC, CCS-P, an independent coding consultant and educator in North Augusta, S.C. "I have always contended that you shouldn't report J2000 for anesthetic use," she says. You have an additional coding dilemma when you determine the diagnosis to use for lidocaine with a Rocephin injection. No ICD-9 code justifies the anesthetic's medical necessity, Callaway says. You would use the child's illness, such as upper respiratory infection (URI), for the Rocephin. But [...]