Wiki Marcaine and Medicare

[complianceforhire]

Hello, I have a coder saying that Medicare's "guidelines" say to use J3490 for Marcaine, even though Marcaine is S0020 (which MC doesn't pay for). I know MC's guidelines can make as much sense as any govt agency, but it seems to me that if MC doesn't pay for S0020, using the J code is basically the same as using an unlisted code to get paid for a procedure when there's an existing code that describes the procedure.

Anybody have some experience with this?

Thanks!

 

[mitchellde]

S codes are non Medicare codes and you cannot use them for Medicare claims. Medicare does not pay separately for bupivacaine (Marcaine) unless it is in an implanted infusion pump. In what context is the drug being used?

 

[complianceforhire]

It's being used as a trigger point inj. I thought this smelled fishy. thx!