Wiki Am I Confused?????? - local anesthesia

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LewinFamily

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I am performing an audit and my facilities are performing basic cystoscopies 52000.. and they are coding for both 52000 AND 96372, J1580 for lidocaine administration....

Am I the one missing something.. Lidociane is pain mgmt (local anesthesia) which is inclusive in surgeries and J1580 is gentamicin (antibiotic)... And no injection is being done what so ever during the encounter...

What am I not understanding? Or am I correct that this should not be going on?

Thanks!
 
Well, if no injection is being done, then 96372 is definitely wrong and J1580 is certainly not for lidocaine so I would say that SOMEBODY is confused but I don't think it's you. ;)
 
http://www.cms.gov/nationalcorrectcodinited/

If some of those cases you are auditing are patients with Medicare primary. I would give them a copy of Chapter 7 of the NCCI policy manual which states:

"Under Medicare global surgery rules, drug adminstration services (CPT 96360-96376) are not separately reportable by the physician performing a procedure for drug adminstration services related to the procedure."

Then Chapter 1 describing what is inclusive to the procedure:

"Local, topical, or regoional anesthesia adminstered by the physician performing the procedure"
 
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