Bladder irrigation for Interstitial cystitis

[desireewhite185@yahoo.com]

Hello,
Has anyone had experience with billing Bladder irrigation for Interstitial cystitis? I have been entering CPT 51700 and for the irrigation solution A4321. (Medicare denies the A4321)
Should I actually be billing each drug used in the solution separately? (5ml Heparin, 20ml lidocaine, 20ml sodium bicarbonate, 2ml methyl prednisolone, 10ml bacteriostatic water) Or should I be billing for the solution at all? Ty!

 

[nielynco]

Hello,
Has anyone had experience with billing Bladder irrigation for Interstitial cystitis? I have been entering CPT 51700 and for the irrigation solution A4321. (Medicare denies the A4321)
Should I actually be billing each drug used in the solution separately? (5ml Heparin, 20ml lidocaine, 20ml sodium bicarbonate, 2ml methyl prednisolone, 10ml bacteriostatic water) Or should I be billing for the solution at all? Ty!

The CPT code covers the administration procedure itself; the instilled substances must be billed separately. Each unit billed must correspond to the dosage administered and so you use J codes for the substance that matches the dosage documented. A4321 is used for cleaning during incontinence care. For the instilled substances you must report a J code for each one. But you must know the dosage, not the amount injected to get to the correct J code. In some cases the provider is using a compounded "cocktail" that has no specific J code and in that case you would report J3490 along with the NDC number of each component. In your case with the drugs listed, it looks like the typical "cocktail" and I would code accordingly.

 

[TKillian]

The CPT code covers the administration procedure itself; the instilled substances must be billed separately. Each unit billed must correspond to the dosage administered and so you use J codes for the substance that matches the dosage documented. A4321 is used for cleaning during incontinence care. For the instilled substances you must report a J code for each one. But you must know the dosage, not the amount injected to get to the correct J code. In some cases the provider is using a compounded "cocktail" that has no specific J code and in that case you would report J3490 along with the NDC number of each component. In your case with the drugs listed, it looks like the typical "cocktail" and I would code accordingly.

Hello,
Has anyone had experience with billing Bladder irrigation for Interstitial cystitis? I have been entering CPT 51700 and for the irrigation solution A4321. (Medicare denies the A4321)
Should I actually be billing each drug used in the solution separately? (5ml Heparin, 20ml lidocaine, 20ml sodium bicarbonate, 2ml methyl prednisolone, 10ml bacteriostatic water) Or should I be billing for the solution at all? Ty!

Hello,
Has anyone had experience with billing Bladder irrigation for Interstitial cystitis? I have been entering CPT 51700 and for the irrigation solution A4321. (Medicare denies the A4321)
Should I actually be billing each drug used in the solution separately? (5ml Heparin, 20ml lidocaine, 20ml sodium bicarbonate, 2ml methyl prednisolone, 10ml bacteriostatic water) Or should I be billing for the solution at all? Ty!

We are trying to bill Medicare for J3490 for Sodium Bicarb, and reporting waste with Mod JW. We are not getting paid for the waste portion of the bottle. We have billed it with one line with JW for what is used, and then again with no modifier for the amount wasted. Medicare is paying the same for the 5 ml we use and the 45 ml we waste? Noridian reps keep referring us to the rules for billing this. Since J3490 is a unlisted procedure code it seems that the reimbursement is like rolling dice. The office is expecting that the use amount allowed should be multiplied by 9 (to match the wastage) I can not find anything clear on what to expect for payment. Any one else doing this successfully? Looking at the Fee Schedule for drugs does not list J3490, and yet it is not on the unpayable drug list either. The NDC code on our bottle is for a 50 ml dose.