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Wiki Durolane Injection Help

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Kris78

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Harlingen, TX
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Hi.

Can someone help me out with the following injection dilemma:

Durolane 60 mg/3 mL intra-articular syringe - Take 3 mL by intraarticular route. Quantity: 3 mL


If the Doctor injected 3ml to the knee and the drug is 60mg/3ml then how would I put this on a claim for the units?

would it be 60 units since j7318 = 1mg??
 
Yes. This would be J7318 x60.
This code is written funny and I had to argue out with the office manager, because she insisted the Dr. didn't need to document dose injected. I received word from corporate coders that yes, the provider needs to document 60 mg and we bill x60.
 
I am having a problem getting Medicaid to accept my durolane claims. When we have called and spoke to the reps at Medicaid they are claiming there is a problem with the NDC number which we have confirmed is correct , 89130202001. Is any one else having issues?
 
Cwirtalla said:
I am having a problem getting Medicaid to accept my durolane claims. When we have called and spoke to the reps at Medicaid they are claiming there is a problem with the NDC number which we have confirmed is correct , 89130202001. Is any one else having issues?
Click to expand...
did you ever get an answer on this topic? I am currently experiencing the same issue. I've billed the 60 units however the carriers are only paying for like 1 unit..
 
Has anyone billed J7318 bilaterally?

Would it be billed as

20610,50 / M17.0
J7318 120 units

OR

20610,LT / M17.12
J7318 60 units
20610,59,RT / M17.11
J7318 60 units

Thanks!
 
Cwirtalla said:
I am having a problem getting Medicaid to accept my durolane claims. When we have called and spoke to the reps at Medicaid they are claiming there is a problem with the NDC number which we have confirmed is correct , 89130202001. Is any one else having issues?
Click to expand...
Check your Medicaid Fee Schedule to see if it is even a payable code.
 
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