Gel-One Hyaluronate Cross-Linked Coding Guide

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Gel-One® Cross-Linked
Hyaluronate Coding Guide
Physician
CPT® Code
CPT Description
20610
Arthrocentesis, aspiration and/or injection, major joint or bursa (eg, shoulder, hip, knee, subacromial
bursa); without ultrasound guidance
20611
Arthrocentesis, aspiration and/or injection, major joint or bursa (eg, shoulder, hip, knee, subacromial
bursa); with ultrasound guidance, with permanent recording and report
Hospital Outpatient and Free-Standing Ambulatory Surgery Center (ASC)
OPPS Status
Indicator
APC
ASC
Payment
Indicator
CPT Code
CPT Description
20610
Arthrocentesis, aspiration and/or injection, major joint
or bursa (eg, shoulder, hip, knee, subacromial bursa);
without ultrasound guidance
T
0204
P3
20611
Arthrocentesis, aspiration and/or injection, major joint
or bursa (eg, shoulder, hip, knee, subacromial bursa);
with ultrasound guidance, with permanent recording
and report
T
0204
P3
OPPS – Outpatient Prospective Payment System; APC – Ambulatory Payment Classification.
Status Indicator T – Multiple procedure reduction applies. APC 0204 – Level I Nerve Injections.
Payment Indicator P3 - Payment based on the Medicare Physician Fee Schedule (MPFS) non-facility Practice Expense (PE) Relative Value Unites (RVUs).
HCPCS
HCPCS Code
HCPCS Description
J7326
Hyaluronan or derivative, gel-one, for intra-articular injection, per dose
HCPCS – Healthcare Common Procedure Coding System.
UPC/NDC
UPC/NDC Code
UPC/NDC Description
87541-0300-91
Gel-One Hyaluronate 3.0 ml
*It may be necessary to utilize the previous NDC number 85836-0151-53 until the payers system is updated.
UPC/NDC Example
Sample ICD-9-CM Diagnosis Codes
ICD-9-CM Code
ICD-9-CM Description
715.16
715.26
715.36
715.96
Osteoarthrosis, localized, primary (lower leg)
Osteoarthrosis, localized, secondary (lower leg)
Osteoarthrosis, localized, not specific whether primary or secondary (lower leg)
Osteoarthrosis, unspecified whether generalized or localized, (lower leg)
Code assignment is based on the physician’s documentation of the patient’s condition. Codes listed are for illustrative purposes, other codes may apply.
Sample ICD-10-CM Diagnosis Codes
ICD-10-CM Code
ICD-10-CM Description
M17.0
M17.10
M17.11
M17.12
Bilateral primary osteoarthritis of knee
Unilateral primary osteoarthritis, unspecified knee
Unilateral primary osteoarthritis, right knee
Unilateral primary osteoarthritis, left knee
M17.2
M17.30
M17.31
M17.32
Bilateral post-traumatic osteoarthritis of knee
Unilateral post-traumatic osteoarthritis, unspecified knee
Unilateral post-traumatic osteoarthritis, right knee
Unilateral post-traumatic osteoarthritis, left knee
M17.4
M17.5
M17.9
Other bilateral secondary osteoarthritis of knee
Other unilateral secondary osteoarthritis of knee
Osteoarthritis of knee, unspecified
Code assignment is based on the physician’s documentation of the patient’s condition. Codes listed are for illustrative purposes, other codes may apply.
For further assistance with reimbursement questions,
contact the Zimmer Biomet Reimbursement Hotline at 866-946-0444 or [email protected]
Zimmer Coding Reference Guide Disclaimer
The information in this document was obtained from third party sources and is subject to change without notice, including as a result in changes in
reimbursement laws, regulations, rules and policies. All content in this document is informational only, general in nature and does not cover all situations or
all payers’ rules or policies. The service and the product must be reasonable and necessary for the care of the patient to support reimbursement. Providers
should report the procedure and related codes that most accurately describe the patients’ medical condition, procedures performed and the products
used. This document represents no promise or guarantee by Zimmer Biomet regarding coverage or payment for products or procedures by Medicare or
other payers. Providers should check Medicare bulletins, manuals, program memoranda, and Medicare guidelines to ensure compliance with Medicare
requirements. Inquiries can be directed to the provider’s respective Medicare Administrative Contractor, or to appropriate payers. Zimmer Biomet
specifically disclaims liability or responsibility for the results or consequences of any actions taken in reliance on information in this guide.
0009.1-EN-en-REV0915
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