Synvisc-I am having issues

lopezk89

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Minnetonka, MN
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I am having issues with kick backs on J7325.RT J7325.LT I don't understand why these are getting kicked back I have never had an issues I took it directly off of the literature the synvisc rep gave me what am I doing wrong. They way I have it billed out is 99213.25 20610.50 J7325.RT and J7325.LT ?????? :confused::confused:
 

dmaec

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aren't the Jcodes billed with units, not RT/LT?
(I don't know for sure, I don't bill codes out! :) ) I'm just tossing that out there !
 

mhstrauss

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aren't the Jcodes billed with units, not RT/LT?
(I don't know for sure, I don't bill codes out! :) ) I'm just tossing that out there !
I agree with this; we bill in units and don't have any problems, as long as the documentation justifies it. :)
 

lopezk89

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Both according to this

On the document it indicates that you use units 16 per injections that per the company and then you indicate the RT and LT so i am super confused. plus the 20610 so i don't know ...
 

mjb5019

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synvisc

The laterality modifiers go on the injection code. They tell the insurance company where the synvisc is injected. WIth your J code you need to tell them how much was injected. How do you have your J codes priced- per mg? per 16 mg?
 

OCD_coder

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Drugs are billed either by per dose or by mgs per the HCPCS book and they are not procedures so the laterallity modifier would not be correct. The only modifier apprpriate for drugs would be the JW for Medicare and a few select commercial payors. It would be a rare and hard to defend event if Synvisc waste was billed.

HCSPCS:
J7324 Orthovisc, per dose (bill per injection 1 x unit)
J7325 Sinvisc or Synvisc-One, 1 mg (bill per mg = 1 unit)

Synvisc comes in preloaded syringes and can be either 16 mg or 48 mgs. Synvisc-One, only comes in 48 mgs that I am aware of.

So if you are billing bilateral injections and you had 48 milligrams given for each knee, you would bill a total of 96 units of J7325 on one line. If you bill on two lines, the second line will be denied as a duplicate.
 

dbellemore

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We also bill the LT/RT on the 20610 and the units on the J code....but what about the E & M and the 25 modifier. I have issues with the 25 modifier on the E & M code. Why not use the 57 modifier for the 1st injection and no E & M charges on the subsequent.
 
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