Hyaluronic Acid Injections: 'Count Correctly' to get your Rightful Reimbursements

For some time, Hyaluronate injections have had its own J code. However it has been changed from 'unspecified' to its own assigned code, back to 'unspecified' and then back to an assigned HCPCS code. Now that all hyaluronate injections fall under the same code, here are three medical coding tips to remember and help you calculate the right way.

Validate the type of medication

Physicians make use of hyaluronate injections to lessen the patient's pain owing to osteoarthritis of the knee. The medications achieve the same purpose and you report both types of injections with J7325. Correct coding depends on the medication used and the number of units you report. Synvisc-One is a one-shot injection equaling 6 cc of the medication. The patient sees your physician once for the full injection, which you report as 48 units of J7325 (2 cc = 16 g, so 6 cc = 48 mg). Physicians administer the other forms of hyaluronate as a series of injections instead of one shot at a single patient visit. Watch the dosage amounts closely so that you will report the correct number of J7325 units for each administration.

Chart note: Owing to the difference in calculations and unit reporting, the doctor must clearly document the medication used and number of units administered. Medication reimbursement can be low; as such wrong or unclear documentation could mean the difference between some payment versus virtually none. Some providers give patients a prescription for hyaluronate (depending on the insurer) and ask them to get the medication and return to the physician's office for the injection.

Injection: Code J7325 represents the medication only; as such you still need to report the injection procedure. Submit 20610; take a look at the diagnosis code. Medicare will only pay for hyaluronate injections to treat osteoarthritis of the knee. You have several diagnosis choices; as such be sure one of these applies to help smooth your claims processing: 715.16, 715.26, 715.36, and 715.96.

Anatomy note: Your 'additional digit' choices for the 715. xx code family do not include a specific option for knee. While selecting the best anatomic choice, take the knee part of the lower leg in place of pelvic region and thigh.

Figure out whether evaluation & management and modifiers apply

Some visits for hyaluronate injections qualify for an evaluation & management code or modifiers; however others do not. If the patient comes to your office specifically for a scheduled Synvisc-One injection, you will only report the injection code. However, if the physician completes another service during the visit, an E/M code might apply.

For more on this and for other medical coding articles to assist your orthopedic coding, sign up for a one-stop medical coding guide like Supercoder.