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Synvisc Billing

  1. #1
    Location
    Albuquerque,NM
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    Default Synvisc Billing
    Medical Coding Books
    synvisc billing i have a J7325 with medicare can you bill this in units and I am confused on the wording of the LCD How many can I bill at one time can I use units and it count as a single procedure do i need to use the EJ modifier. I am total lost lol.

  2. #2
    Location
    Tacoma, WA
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    Quote Originally Posted by lopezk89 View Post
    synvisc billing i have a J7325 with medicare can you bill this in units and I am confused on the wording of the LCD How many can I bill at one time can I use units and it count as a single procedure do i need to use the EJ modifier. I am total lost lol.

    This is from the Trailblazer LCD for this injection. What I get from the instruction is:

    ..a series is 3 to 5 injections done once a week for 3 to 5 weeks (1 per week). The initial injection does not require the EJ modifier, but the subsequent injections in that series do require the modifier to indicate they are part of a series. The modifier is attached to the drug code only. If another series was initiated, you would follow the same guideline, the first one no modifier but susequent ones in the series a modifier. You bill each injection as a single unit for the date of service it is provided.


    "The frequency of injections is:

    An initial series of three to five weekly injections per knee. Note: Synvisc-ONE is administered through a single intra-articular injection.
    A repeat series of injections for patients who have responded to the first series may be given individual consideration by Medicare for coverage under the following circumstances:
    The medical record objectively documents significant improvement in pain and functional capacity using a standardized assessment tool.
    Or,
    The medical record documents significant reduction in the doses of non-steroidal anti-inflammatory medications taken or reduction in the number of intra-articular steroid injections to the knees during the six-month period following the injection.
    And,
    At least six months have elapsed since the prior series of injections.
    A series is defined as a set of injections for each joint and each treatment. The EJ modifier must be used with the HCPCS code for the drug administered to indicate subsequent injections of a series. The modifier is not to be used with the first injection of each series.

    The appropriate records documenting the improvement must be maintained in the medical record and made available to Medicare upon request.

    If the series of injections using sodium hyaluronate did not prove to be beneficial to the patient, it would not be reasonable to repeat the therapy again using any of these products. Thus, a repeat series of injections would not be covered"
    Arlene J. Smith, CPC, CPMA, CEMC, COBGC

  3. #3
    Location
    Albuquerque,NM
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    59
    Default thank you
    So why would you bill 16 units and get paid on it is that an error on there part . Was this person miss informed I just want to make sure that I send it out right and not incorrectly.

  4. #4
    Location
    Tacoma, WA
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    Quote Originally Posted by lopezk89 View Post
    So why would you bill 16 units and get paid on it is that an error on there part . Was this person miss informed I just want to make sure that I send it out right and not incorrectly.
    Whoa! No clue what you are talking about there. The J code you listed is for 1mg of the drug. Does your provider inject more than 1 mg per injection? If so, then you would bill the number of units to equal how many "mg" are injected in that one session, and then for each session in the series. Otherwise, if the provider is just injecting 1mg you use 1 unit in your billing.
    Arlene J. Smith, CPC, CPMA, CEMC, COBGC

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