Wiki PAIN MANAGEMENT J3300 QUESTION

[amowens854]

I have a question for the Pain Management Coders out there.
I came across an article about the code J3300 (Triamcinolone acetnide(Kenalog) PF) and reporting wastage.
I just wanted to make sure that I was doing it correct.

EXAMPLE
Note from chart
After obtaining informed written consent, the patient was taken to procedure room and placed in the prone position. The site of pain and procedure were confirmed with the patient. Routine monitors were applied. The L5-S1 interspace was identified under fluoroscopic guidance. The skin overlying the lumbar region was prepped and draped as a sterile field. Local anesthesia was obtained with 3cc of 1% Lidocaine PF. Using a 20-gauge Tuohy needle, the epidural space was identified with a loss-of-resistance technique. Aspiration was negative for CSF, blood, or other bodily fluids. Next, 1-5cc of Omnipaque 240mgI/mL was injected to confirm the epidural needle placement was negative for intrathecal injection. Then, Kenalog 80mg PF suspended in 1cc of 0.25% Bupivicaine PF was easily injected into the epidural space without apparent complication. The Tuohy needle was then cleared with 0.5cc of 1% Lidocaine PF and removed intact. The back was cleansed and sterile dressing applied. The patient was taken to the recovery room in satisfactory condition where the patient was observed and subsequently discharged home. There were no complications. The patient received post-procedure discharge instructions

Doctor is using a 5ML single dose vial 40mg/1ML
J3300-80units
J3300-120 units wasted

So J3300X80units
J3300X120 JW
Any input would be great! TIA

 

[SharonCollachi]

You cannot bill wastage if it is not documented in the medical records.

You may also want to consider purchasing 1ml vials, and using two, instead of purchasing 5ml vials.

 

[mcdream]

Feedback please- Is my conversion correct?

Scenario:
1.5 cc of medication: mixture of 1 cc of Kenalog-10 and 0.5 cc of 1% lidocaine with epinephrine.
Since cc was administered & the drugs table is in mg, I need to convert cc to mg- correct?
I believe cc & mL are used interchangeably: 1cc=1mL (it's a 1:1 conversion ration)?
And the conversion of 30mg=1mL/1cc- correct?

Kenalog-10 on the Table of Drugs directs you to:
-Triamcinolone Acetonide: INJ >unit per 1mg>J3300
-Triamcinolone Acetonide: IM >unit per 10 mg>J3301
Kenalog was administered for keloid on neck

If my conversion is correct then I believe 1cc of Kenalog-10 depending on the 'route' would be coded as:
INJ: J3300X30
IM: J3301X3

Additional Question: Scenario was for a mixture of 1cc of Kenalog and 0.5cc of 1% lidocaine with epinephrine (total medication mixture 1.5cc), do I also need to code for the 0.5cc of 1% lidocaine with epinephrine (if so, how would I locate that code-I don't see one)?

Thank you in advance for your guidance on drug table conversions. Anyone have a link to a conversion chart?

 

[SharonCollachi]

J3300 is preservative-free triamcinolone acetonide, per 1 mg
J3301 is not-otherwise-specified triamcinolone acetonide, per 10 mg

We use Kenalog with preservatives, so we bill with J3301

1.5 cc of medication: mixture of 1 cc of Kenalog-10 and 0.5 cc of 1% lidocaine with epinephrine.
Since cc was administered & the drugs table is in mg, I need to convert cc to mg- correct?
I believe cc & mL are used interchangeably: 1cc=1mL (it's a 1:1 conversion ration)?

CC and ML are the same thing, so yes, no actual conversion, 1:1

And the conversion of 30mg=1mL/1cc- correct?
If my conversion is correct then I believe 1cc of Kenalog-10 depending on the 'route' would be coded as:
INJ: J3300X30
IM: J3301X3

It's not the route of administration, it's whether it has preservatives or not.

I'm not following your math here. You used one cc of Kenalog 10mg/ml, or 10 mg. J3300 would be 10 units and J3301 would be one unit. Where is 30mg coming from? It would be 30 if you used 3ml or 3cc.

Additional Question: Scenario was for a mixture of 1cc of Kenalog and 0.5cc of 1% lidocaine with epinephrine (total medication mixture 1.5cc), do I also need to code for the 0.5cc of 1% lidocaine with epinephrine (if so, how would I locate that code-I don't see one)?

lidocaine or marcaine is always included in the injection procedure performed, so you do not bill it separately.

Sharon