Supartz J7321

tbolla

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I need some clarification about J7321. The description for this code is: Hyaluronan or derivative, hyalgan or supartz, for intra-articular injection, per dose. My provider's secondary office insists that because the drug is 25mg/2.5ml, they can bill 2 units to Medicare and 3 units to commercial payers so he wants it billed this way in his primary office. They were told by someone at Medicare that it is acceptable. I disagree with this as I cannot find anything that supports each "dose" being 1ml. The Supartz website lists each syringe as 25mg.

What do you all do as far as the number of units and how are you interpreting the code description?

To be clear, we are talking about a single injection into one knee, not a bilateral procedure.

Thanks in advance!
 

mhstrauss

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I need some clarification about J7321. The description for this code is: Hyaluronan or derivative, hyalgan or supartz, for intra-articular injection, per dose. My provider's secondary office insists that because the drug is 25mg/2.5ml, they can bill 2 units to Medicare and 3 units to commercial payers so he wants it billed this way in his primary office. They were told by someone at Medicare that it is acceptable. I disagree with this as I cannot find anything that supports each "dose" being 1ml. The Supartz website lists each syringe as 25mg.

What do you all do as far as the number of units and how are you interpreting the code description?

To be clear, we are talking about a single injection into one knee, not a bilateral procedure.

Thanks in advance!
We bill 1 unit per syringe(dose) used. I found this article from CMS that agrees with this (published 2010):

http://www.cms.gov/medicare-coverage-database/lcd_attachments/30149_7/012010_00115_L30149_INJ033_cbg.pdf

Supartz is covered in #1 in the article. It's possible that they are getting this confused with Synvisc for the "1mg" info, since that drug is billed differently, per mg.
The HCPCS description for J7321 does clearly state "per dose", which is 25mg. So unless its an atypical case, which should be clearly documented, it should be billed as 1 unit.

Hope this helps!! :D
 

tbolla

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This is very helpful, thank you!
I'm having a tough time convincing my provider because his other biller has been "doing it that way for years and getting it paid". I really think that Medicare was maybe processing it because 2 is allowed for bilateral procedures. I'm really surprised they were not denied.
 
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