One of my providers wants to use J1885 Toradol (ketorolac) and administer it into the shoulder joint using 20610 large joint arthrocentesis code. The physician states there have been studies that this is an effective use of the drug. Everything I have read about it states it is administered IM or IV using the CPT code 96372. Can you clarify if this drug can be used and billed for payment using the CPT 20610 and J1885.
You are correct that the prescribing information for Toradol (ketorolac) injectable lists the routes of administration as IM and IV. For a drug like Depo-Medrol (methylprednisolone), the route of administration is listed as IM, intra-articular, soft tissue and intralesional. The decision to use a medication for “off label” use is a medical one. However, the payers may have a payment policy that only reimburses when the drug is administered as directed and for the listed uses. You would need to check with the individual payers and, based on that information, determine if the service is reimbursable by the patients insurance or, if not, if you have the ability to charge the patient directly for that service and medication.