## **What is the HCPCS code J7312 for?**
The HCPCS code J7312 is one of the many J codes that designate injected medications. In the context of this code, what is being injected is an intravitreal implant containing dexamethasone. The implant (marketed as Ozurdex) typically contains 0.7 mg of dexamethasone, and billing is calculated in 0.1 mg increments, meaning each implant is billed as 7 units of J7312.
The implant is injected into the eye. What the implant does is to slowly release the medication over time, and what this medication does is to reduce ocular inflammation and swelling in the retina, which restores vision (assuming it has been affected by the swelling), reduces ocular itching, and prevents any further damage to the eye caused by the inflammation and swelling.
This medicine is used on patients who have eye problems like central retinal vein occlusion, branch retinal vein occlusion, diabetic macular edema, or noninfectious posterior uveitis.
Please note that this isn't surgically implanted. It's injected using a special applicator specifically designed to deliver it. It's also for retinal problems, so it can only be used on something like non-infectious uveitis affecting them, not something like allergic conjunctivitis.
Also, just in case your patient starts to wonder, the medicine's effects will only become noticeable in a few weeks after the injection because of its sustained release.
## **Documentation requirements for J7312**
As with any procedure, especially involving injecting drugs into patients, it's important to document the following before you file for a claim that includes this code:
- The full name of the personnel who administered the injection and their credentials
- The name and address of the facility where the injection was administered
- The full name of the patient
- The date and time of the drug administration by injection
- Patient records showing they have been diagnosed with eye problems that cause inflammation/swelling in the eye (e.g., noninfectious posterior segment uveitis, diabetic macular edema)
- Imaging such as optical coherence tomography (OCT) or fluorescein angiography to confirm macular edema in the affected eye
- The exact dosage (every 0.1 mg = 1 unit)
## **Billing requirements for J7312**
Besides the documentation requirements above, please note the following billing requirements for this specific code:
- The relevant ICD diagnosis codes for their eye problems affecting them
- They must reflect the dosage given over the course of the treatment.
- Use either of two modifiers; always use JZ if the implant is successful, and only use JW on the rare instance that the procedure is unsuccessful and the implant is discarded before being administered to the patient.
- Please use either the RT or LT modifier. The former is for the right eye, the latter for the left. If it's bilateral, the modifier is -50.
Please follow guidelines set by the CMS/Medicare/similar providers to ensure smooth billing and avoid claim rejections.
## **Other similar codes**
- **J7311** - Injection, fluocinolone acetonide, intravitreal implant (retisert), 0.01 mg
- **J7313** - Injection, fluocinolone acetonide, intravitreal implant (iluvien), 0.01 mg
- **J1096** - Dexamethasone, lacrimal ophthalmic insert, 0.1 mg
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