• BILLING AND CODING

    1% Sodium Hyaluronate must be administered by a healthcare professional1. Reimbursement procedures may vary depending on how the product is procured (e.g., buy and bill, pharmacy).

    OR

    Medical Benefit

    If you acquire 1% Sodium Hyaluronate through your wholesaler you will:

     

    • Order the product
    • Manage the inventory
    • Bill health insurers for the product, office visit, and administration
    • Collect co-pays from patients for their share of office visit and administration costs


    Generally products administered and billed by providers are reimbursed under the medical benefits. Coverage varies among insurers.

    Pharmacy Benefit

    If the patient obtains 1% Sodium Hyaluronate and has it either shipped to your office or shipped to themselves and brings it to your office:

     

    • The pharmacy will bill the health insurer for the product and collect the co-pay for the product from the patient.
    • You would bill the health insurer for the office visit and administration and collect the co-pay from the patient for their share of these costs.


    While products purchased directly by patients are generally covered under pharmacy benefits, charges for office visits and administration are usually covered under medical benefits.


    Billing and Coding Information

    J CODE:

     

        • J7331: SynoJoynt, Inj., 1 mg. The long descriptor is “Hyaluronan or derivative, SynoJoynt, for intra-articular injection, 1 mg2.
        • IMPORTANT NOTE: Teva's product is labeled as “1% Sodium Hyaluronate,” however it's listed in the HCPCS code set as “SynoJoynt.”

     

     

    CPT CODES:

     

        • 20610: Arthrocentesis, aspiration and/or injection, major joint or bursa (e.g., shoulder, hip, knee, subacromial bursa); without ultrasound guidance3
        • 20611: Arthrocentesis, aspiration and/or injection, major joint or bursa (e.g., shoulder, hip, knee, subacromial bursa); with ultrasound guidance; with permanent recording and reporting4

     

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IMPORTANT SAFETY INFORMATION

Contraindications

Do not use 1% sodium hyaluronate to treat patients who have a known hypersensitivity to hyaluronan preparations. Do not use to treat patients with knee joint infections or to treat patients with infections or skin disease in the area of the injection site.

Warnings

Do not concomitantly use disinfectants containing quaternary ammonium salts or chlorhexidine for skin preparations because hyaluronan can precipitate in their presence. Do not inject intravascularly because intravascular injections of 1% sodium hyaluronate may cause systemic adverse events.

Precautions

  • Patients having repeated exposure to 1% sodium hyaluronate have the potential for an immune response; however, this has not been assessed in humans.
  • The safety and effectiveness of 1% sodium hyaluronate in conjunction with other intra‐articular injectables, or into joints other than the knee, have not been established.
  • Remove any joint effusion before injecting.
  • Transient pain or swelling of the injected joint may occur after intra‐articular injection with 1% sodium hyaluronate.
  • The effectiveness of repeated injection cycles of 1% sodium hyaluronate has not been established.
  • The contents of the syringe must be used immediately after its packaging is opened. Do not re-sterilize the product.
  • Strict aseptic administration technique must be followed.
  • Do not re-use. Dispose of the syringe and any unused 1% sodium hyaluronate after use.
  • Do not use if the syringe blister package is opened or damaged.
  • The route for intra-articular injection should be chosen so that damage to adjacent vital structures is avoided.
  • An increase in injection pressure may indicate incorrect extra-articular placement of the needle or overfilling of the joint.
  • Local anesthetics should not be used if the patient is known to be allergic or sensitive to local anesthetic.
  • 1% sodium hyaluronate should be used with caution in patients with pre-existing chondrocalcinosis as injection may lead to an acute attack of the condition.
  • As with any viscosupplementation treatment, the patient should avoid any strenuous activities or prolonged (i.e. more than an hour) weight bearing activities within 48 hours following intra-articular injection.

Adverse Reactions

The following treatment emergent adverse events occurred in ≥1% of patients who received 1% sodium hyaluronate in a controlled clinical study:

Arthralgia, upper respiratory tract infections, injection site joint pain, nasopharyngitis, bronchitis, joint swelling, joint crepitation, joint effusion, osteoarthritis, headache, cough, diarrhea, nausea, injection site pain, edema peripheral, urinary tract infection, herpes zoster, muscle strain, back pain, and sciatica.

Potential Adverse Effects of the Device on Health

Potential adverse effects (e.g., complications) associated with the use of this device and, in general, associated with intra-articular injection devices for the treatment of pain in osteoarthritis of the knee, include: aggravated osteoarthritis, injection site reaction, arthralgia (knee pain), localized osteoarthritis, arthropathy, joint (knee) disorder, arthrosis, joint (knee) swelling, Baker’s cyst, joint (knee) effusion, bursitis, joint (knee) stiffness, immune response, pain in limb, infection, paraesthesia, injection site erythema, phlebitis, injection site edema, pruritus, injection site pain, and tendonitis.

Incidences of rash, headache, dizziness, chills, hives, nausea, muscle cramps, peripheral edema, and malaise have also been reported in association with intra-articular injections.

Please see full Product Information.

REFERENCES

1.

1% Sodium Hyaluronate [Product Information]. North Wales, PA: Teva Pharmaceuticals, Inc; 2019.


2.

HCPCS Codes J7331. https://hcpcs.codes/j-codes/J7331/. Accessed November 18, 2019.


3.

AAPC Coder. CPT 20610, Under General Introduction or Removal Procedures on the Musculoskeletal System. https://coder.aapc.com/cpt-codes/20610. Accessed June 26, 2019.


4.

AAPC Coder. CPT 20611, Under General Introduction or Removal Procedures on the Musculoskeletal System. https://coder.aapc.com/cpt-codes/20611. Accessed June 10, 2019.