Q&A: Billing anesthetic drugs with injection procedures

Q: My coders tell me that billing anesthetic drugs with injection procedures is unbundling and are reversing charges on outpatient clinic encounters.

Example 1: The procedure was 20610. The drugs given were Ketorolac (J1885), Ropivacaine (J2795), and M-Pred Acet (J1040). The drugs were drawn into one syringe. The coder reversed J2795.

Example 2: The procedure was 20523. The drugs given were Ropivacaine (J2795) and Lidocaine. The coder reversed both charges.

The "-caine" drugs are packaged into the procedure and bring no separate reimbursement. My understanding is that if the purpose of the drug is for numbing/analgesia, then we shouldn't bill, but if they're used for therapeutic purposes, then it's okay. If given with other drugs as in Example 1, does it make them therapeutic? Since they're the only drugs in Example 2, then is the purpose numbing/analgesia?

A: If the anesthesia department has the cost for the drugs and is looking for a way to capture that, it is appropriate to charge for single-dose vial drugs used in the procedure. Therapeutic injection/infusion codes should not be charged, as they are inherent to the procedure.

Most of the “-caine” drugs come in a multi-dose vial and would not be a separately chargeable item. Some facilities take the philosophy that all drugs should be packaged, and the costs rolled into the different anesthesia levels, although they could be leaving dollars on the table if the drugs have separate reimbursement associated with them. It is important to know if historically all drug costs have been included in the levels, and if so, whether an analysis is being performed to assess the level pricing, should you choose to charge the drugs separately. You do not want to double dip if they are currently rolled into the levels. The tricky part is finding documentation to support the methodology being used. If you change it, document it for the future.

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