Newsletter Coding Advice May Already Be Outdated
Does your practice receive and use newsletters on coding? Some printed advice was distributed before Medicare introduced the new Q codes for the hyaluronate products into HCPCS coding. The coding reference you rely on may in fact be incorrect.
With any changes in Medicare codes, the Centers for Medicare & Medicaid Services (CMS) is the authority. Publishers of off-the-shelf products—such as Ingenix, PMIC, and other private companies—are not “official” sources of coding information. They rewrite what has already been published by CMS.
Medicare created the new Q codes and revised the ASP file even after its final rules were published in the Federal Register—this is not uncommon. Publishers found the J codes still in the Federal Register and printed their books before CMS introduced the Q codes. The off-the-shelf manuals will be updated probably within the next few months, but in the meantime, they are incorrect.
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If you use an off-the-shelf coding manual:
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Physicians must use the new Q codes to get reimbursement for hyaluronate injections, even if some coding manuals or newsletters still list the J codes.
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Private publishing companies are not official sources of Medicare coding information and their information is sometimes outdated.
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Remember that, regardless of what your coding book or newsletter says, CMS is the authority for Medicare coding changes.
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Bottom line: The codes for hyaluronate injections J7317, J7319, and J7320 have been eliminated, are not associated with any fees, and if used will not bring your practice any reimbursement. The correct HCPCS codes replacing the J codes are as follows:
| Q4083 Hyalgan or Supartz |
inj. PER DOSE $105.558 |
| Q4084 Synvisc |
inj. PER DOSE $198.089 |
| Q4085 Euflexxa |
inj. PER DOSE $115.155 |
| Q4086 Orthovisc |
inj. PER DOSE $200.541 |
Private payors who do not recognize CMS codes will use A codes or the generic supply code. For these insurance companies, the change from J codes to Q codes is irrelevant.
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