64400 and J2001

[Jinx75]

If the Dr performed a Trigeminal Nerve Block with Lidocaine Infusion in an outpatient hositpal setting where the lidocaine she is infusing is not her own (but rather the facilities), can she bill the J2001?

 

[dwaldman]

The facility would report J2001 as they incurred the cost of the drug. J2001 would not represent the physician work of the infusion.

Below is some examples of codes that might describe an infusion but in a facility setting there are restrictions from the physician reporting these types codes; additionally review excert from the NCCI policy manaul

96365 Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); initial, up to 1 hour (List separately in addition to code for primary procedure)

96366 Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); each additional hour (List separately in addition to code for primary procedure)

96374 Therapeutic, prophylactic or diagnostic injection (specify substance or drug); intravenous push, single or initial substance/drug

96375 Therapeutic, prophylactic or diagnostic injection (specify substance or drug); each additional sequential intravenous push of a new substance/drug (List separately in addition to code for primary procedure)

96376 Therapeutic, prophylactic or diagnostic injection (specify substance or drug); each additional sequential intravenous push of the same substance/drug provided in a facility (List separately in addition to code for primary procedure)


6. CPT codes 96360-96379, 96401-96425, and 96521-96523 are reportable by physicians for services performed in physicians' offices. These drug administration services should not be reported by physicians for services provided in a facility setting such as a hospital outpatient department or emergency department. Drug administration services performed in an Ambulatory Surgical Center (ASC) related to a Medicare approved ASC payable procedure are not separately reportable by physicians. Hospital outpatient facilities may separately report drug administration services when appropriate. For purposes of this paragraph, the term “physician” refers to M.D.'s, D.O.'s, and other practitioners who bill Medicare claims processing contractors for services payable on the “Medicare Physician Fee Schedule”.

 

[Limbanidd2012@gmail.com]

Hi!

Please help me for below procedure.

diagnostic bilateral lumbar facet joint injections at L2-3, L3-4, and L4-5 with fluoroscopic guidance. CPT codes are 64493–50 and 64494–50.

the patient was taken to the operating room and placed on the operating room table in the prone position. All pressure points were well padded. A timeout was performed prior to the procedure and there was agreement between the OR staff and the patient. The patient was monitored and sedated by members of the anesthesia department.

Under fluoroscopic imaging in the PA and oblique views, the facets at the appropriate levels were identified and the target sites over each facet, more marked with a marking pen on the skin. The back was prepped with Hibiclens and draped in sterile fashion. The skin over each target site was anesthetized with Marcaine 0.25% equal to 2 cc Then each level Center with a 22-gauge 7 inch block needle. The needle tips were guided to the junction of the transverse process and the pedicle of the appropriate facets.

aspiration was negative for blood and CSF.

Then, each level was injected with Marcaine 0.25% equal to 1 cc and lidocaine 1%

For lidocaine and marcaine we dont get payment. lidocaine J2001(for IV) which is not billable and second one is marcaine which is also not billable for medicare. Kindly provide any suggestion. Shall we bill only 64493 and 64494 without any J code which is payable or not?