Hyalgan Injections

ercoder65

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Des Moines
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I need some help on this. A PA that I code for wants to start injecting patients with Hyalgan (J7321), but she was told by a PA friend that she won't get paid unless the first injection (in a series of 5) was performed by a physician. Does anyone know if there is truth to this? I had not heard of this before and I don't know where to go to get a valid answer. Thanks in advance!

Sincerely,

Rich
 

RebeccaWoodward*

True Blue
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North Carolina
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No...I have not heard of this requirement. We perform this procedure and it does require a diagnosis of osteoarthritis. As you know, some carrier have specific requirements such as.....

Intra articular hyaluronan injections may be appropriate for the treatment of pain in osteoarthritis of the knee when conservative treatment has failed.

The medical record should document conservative therapy as follows:

• Diagnosis of osteoarthritis substantiated by x-ray or other imaging or arthroscopic findings, and
• Complaints of persistent pain while using simple analgesics and non-steroidal anti-inflammatory drugs,
and
• Aspiration of the joint resulting in clear viscous aspirate, when effusion is present, followed by injection of steroid that results in unsatisfactory relief of pain or relief of pain that lasts less than three months.
 

melawar

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Farmington, nm
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Hyalgan

Does Medicare pay for this injection? Also the code does not specify the dosage, does it get billed with just 1 unit?

Thanks
 
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