Hyalgan Injection CPT Code

David Fuller

Last Updated On: June 5, 2024

CPT codes related to the administration of hyaluronan, like Hyalgan, have become increasingly significant. These codes facilitate accurate billing and reimbursement for the intra-articular injection of this hyaluronan derivative, ensuring that healthcare providers can efficiently document and claim reimbursement for their services.

Hyalgan offers relief to patients suffering from knee OA. By replenishing synovial fluid, Hyalgan alleviates pain and improves joint function. Patients who have failed other treatments find solace in this minimally invasive procedure. Its safety profile and efficacy make it a preferred choice for managing knee pain associated with OA.

In this article, we will explore Hyalgan’s mechanism of action, clinical indications, and the nuances of proper administration.

Key Takeaways

• Hyalgan injections are a form of viscosupplementation used to treat knee osteoarthritis.
• The specific CPT code for billing Hyalgan injections is essential for accurate medical documentation and insurance claims.
• When using the CPT code for Hyalgan injections, patient eligibility, documentation requirements, and coding guidelines must be followed.
• Proper usage of the CPT code in different clinical scenarios is crucial for compliance with billing regulations.
• Identifying and avoiding common coding errors related to Hyalgan injections is essential for accurate billing practices.

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Overview of Hyalgan and Viscosupplementation

Hyalgan injections can help relieve knee pain and improve mobility in patients with osteoarthritis. This treatment involves injecting a substance that acts as a lubricant and shock absorber into the knee joint, smoothing movement. Proper billing and coding for Hyalgan injections are crucial for medical professionals to ensure patients can effectively use their insurance benefits.

Identifying the Specific CPT Code for Hyalgan Injections

Finding the correct CPT code for Hyalgan injections is crucial for proper medical documentation and insurance claims. The primary billing codes for Hyalgan injections are 20610 or 20611, depending on whether it’s a single shot or part of a series for knee osteoarthritis. 

The modifier “-50” might be required for treatments on both knees, with these codes to indicate bilateral procedures. Using the specific HCPCS code J7321 for Hyalgan injections and the NDC number on claim forms ensures accurate billing and fair reimbursement.

Criteria for Using the CPT Code

To use the Hyalgan injection CPT code correctly, doctors must know if a patient should get the shot and what to write down for insurance. They also need rules to follow so they charge correctly every time.

Doctors often choose Hyalgan injections for knee osteoarthritis patients who haven’t found relief from exercise or pain medicines. Ideal candidates are those whose knee pain impacts daily life. Hyalgan provides cushion and lubrication to the knee joint, mimicking natural joint fluid.

Aside from these codes, healthcare professionals should make patients understand how to compare Hyalgan vs. Euflexxa or Orthovisc and be aware of possible side effects. This understanding will help them choose the proper treatment that will help them achieve their goals.

Proper Usage and Compliance with Billing Regulations

Using the correct CPT code for Hyalgan injections is crucial for medical billing. This method ensures that healthcare providers get proper reimbursement for treating knee osteoarthritis.

• A patient comes in for their first Hyalgan injection to treat knee pain due to osteoarthritis. The doctor uses code 20610 because it’s a single injection session. They also include the HCPCS code J7321 and the NHRIC catalog number 89122-0724-20 on the claim form.
• Another patient receives multiple Hyalgan injections in both knees during a follow-up visit. Here, code 20611 applies, with an added modifier “-50” to indicate bilateral treatment.
• A scenario arises where aspiration is performed alongside the Hyalgan injection in one session. In such cases, only one CPT code 20610 or 20611 unit should be billed to avoid coding errors.
• For those working in a hospital outpatient setting, billing Hyalgan under insurance claims may need both CPT codes 20610/20611 with modifier “-50” and J7321 to document bilateral administration correctly.

Common Coding Errors and How to Avoid Them

It’s crucial to avoid mistakes when coding for Hyalgan injections. Using the correct CPT code (20610 or 20611) and HCPCS code (J7321) is essential. Understanding when to use modifiers, such as “-50” for bilateral knee treatments, is also necessary. 

Double-checking your claim form’s HCPCS code and NDC number is necessary to prevent errors. Billing for aspiration and injection in one visit should only occur once using 20610 or 20611. Ensuring accurate documentation and using the correct codes fosters patient trust and prevents claim denials.

Conclusion

Understanding the CPT code for Hyalgan injections is crucial for medical professionals. Correct codes and modifiers like “-50” or “EJ” make billing smoother. Including HCPCS codes and proper documentation ensures accurate reimbursement for treating knee osteoarthritis. 

FAQs

1. What is the CPT code for a Hyalgan injection?

The CPT code for a Hyalgan injection is 20610.

2. Can the same CPT code be used for Hyalgan injections in both knees?

Yes, the same code, 20610, can be used for injections in both knees.

3. Are any modifiers required for the Hyalgan injection CPT code?

Yes, modifiers may be needed depending on insurance and treatment of multiple sites.

4. Is there a limit on the annual usage of CPT code 20610 for Hyalgan injections?

No set limit exists, but insurance plans may have coverage guidelines.

5. Will Medicare cover a Hyalgan injection under CPT code 20610?

Yes, Medicare generally covers it under CPT code 20610, but verify with your specific plan.

References

Hyalgan Reimbursement Guide. Hyalgan website. https://hcp.hyalgan.com/wp-content/uploads/sites/4/2021/04/FCOR-2107-Hyalagan-Reimbursement-Guide-Update_L51.pdf. Published April 2021. Accessed May 29, 2024.

Intro to CPT Coding – MedicalBillingandCoding.org. https://www.medicalbillingandcoding.org/intro-to-cpt/