Ask the Expert

This month’s selection:
Can anyone indicate Centers for Medicare & Medicaid Services (CMS) (or any other) guidelines for where to find therapeutic marcaine (billable) vs. not payable when billed with Depo. There is a huge debate where I work as to whether or not marcaine can be billed/paid when mixed with Depo/Kenalog. Then the doctor writes on the charge ticket that marcaine is therapeutic but mixed with another prescription. My understanding is that the doctor can write therapeutic but if marcaine (-caine) is mixed with another drug, it is no longer payable as therapeutic.

Anonymous

Response:
I’m guessing this is a facility billing, not the doctor billing, and that it’s Medicare or all payers? The CPT codes themselves and what’s being injected may be the problem, not any CMS regs.

The code for Injection, spinal nerve root, single, cervical, analgesia only (therapeutic marcaine) is 62310 and the ambulatory payment classification (APC) for Medicare is 207. The code for Injection, spinal nerve root, single, cervical, analgesia mixed with steroid, is still 62310 and the APC is still 207, so the payment will not change from injection of marcaine alone.

If you look at the ICD-9 procedure codes, they differentiate what’s getting injected separately, but CPT doesn’t care. Since these are generally outpatient procedures, they will get reported with CPT codes as follows:

• 03.91 injection into spinal canal for analgesia (marcaine);
• 03.92 injection of other agent (steroid) into spinal canal; and
• 99.23 injection of steroid (to identify the “other” agent).

— Judy Sturgeon, CCS, is the clinical coding/reimbursement compliance manager at Harris County Hospital District in Houston and a contributing editor at For The Record. While her initial education was in medical technology, she has been in hospital coding and compliance for 21 years.