Advanced Revenue Cycle Analytics: An Overview

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As of January 1, 2019, a new HCPCS code J7318 “Hyaluronan or derivative, durolane, for intr-articualr injection, 1mg” became available to treat joint pain (Knee, hip, and other joints) usually caused by osteoarthritis. Typically, durolane is administered to patients when other osteoarthritis treatments or pain drugs have proven ineffective.

Osteoarthritis (OA) occurs when cartilage in the joints breaks down and no longer cushions the bones, causing pain and inflammation as the bones rub together. Durolane is injected into the patient’s joint(s) to lubricate and cushion the joint in order to relieve pain. Durolane should not be administered when there is an infection in the joint or in the skin around the joint. The positive effects of the injection can last up to 6 months.

Durolane is normally given in a single dose injection of 60mg/3ml. Since the base amount of J7318 is 1mg, it is a good idea for practices to program J7318 to automatically apply 60 units in order to avoid missed revenue. For White Plume clients, we can take joint injection coding to the next level by creating combo codes that include the joint injection (20610/20611), the modifier (RT/LT/Bilateral), and the drug (J7318x60), so that physicians can select all appropriate codes in a single click.

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