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Wiki Coding Knee Injections

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barb6551

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We have only four J-codes for the Blues to use this year for knee injections, does anyone use J7321 for one of the codes? We used it and were denied stating we needed a prior authorization.
 
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At our clinic, our Blues don't deem it medically necessary so we can't bill any of the J-codes (visco supplementation) except for cortisone. We have to get authorization and approval through the patients specialty pharmacy, otherwise they have to pay out of pocket. Going through the patients specialty pharmacy isn't a guarantee that they will authorize and allow the patient to receive these injections. I would recommend pulling the visco supplementation policy every year to see what they are requiring for authorization. It was hard for us to inform all our Blue patients that their insurance no longer covers the medication for the injections, however there was a slim possibility that we could get it through the specialty pharmacy.
 
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