HCPCS Code J7324: Hyaluronan or Derivative, Orthovisc, for Intra-Articular Injection, Per Dose

Learn about the HCPCS code J7324 for "Hyaluronan or derivative, orthovisc, for intra-articular injection, per dose" through this guide.

Use Code

## **What is the HCPCS code J7324 for?** The HCPCS code J7324 is a J code that's meant to designate the provision of an orthovisc injection (hyaluronan or derivative), specifically per dose. This single intra-articular injection is meant to be used on patients dealing with osteoarthritis of the knee joint (e.g., symptomatic osteoarthritis, unilateral secondary osteoarthritis, bilateral secondary osteoarthritis). This specific hyaluronic acid injection provides lubrication to the knee joint, which improves joint mobility and functional capacity. It also provides cushioning, which provides knee pain relief. All these benefits will help improve the overall quality of life of the patient. For this injection to be a viable treatment choice, patients should have undergone other forms of treatment, but didn't respond well to them (e.g., physical therapy, steroid injections, using NSAIDs). It'll usually take 15 to 20 minutes to administer this injection, but this doesn't count preparation and post-injection observation. It's important to monitor your patient for a bit after injecting the drug because this injection has risks, which include infections, allergic reactions, increased pain in the knee joint, and bleeding in the knee joint.

## **Documentation requirements for J7324** As with any HCPCS code, you'll need sufficient documentation that meets coding guidelines and requirements of your insurer, as well as any related policy articles and local coverage determinations applicable to you. Here are examples of what you'll need: - The full name of the patient - The full name and credentials of the healthcare professionals who handled the patient - The name and address of the facility where the injection was administered, along with information as to what kind of facility it is - The relevant information and indications based on your patient's medical record to justify medical necessity, such as relevant knee osteoarthritis diagnoses, imaging test results, records that they didn't respond adequately to conservative treatment and others - The drug's information (e.g., drug name, strength, dosage, route of administration, the specific injection site, drug manufacturer, lot number, expiration date, etc.) - Therapeutic goals - Date of last injection (if this injection is part of subsequent courses/subsequent injections indicated in a treatment plan)

## **Billing requirements for J7324** Besides the documentation requirements above, please make sure to take note of or have the following: - 1 dose of drug administered = 1 unit - Use any relevant ICD codes (use a specific code based on the patient's condition) - Use CPT code 20610 or 20611 since this is a knee joint injection - Use modifier RT if the injection is for the right knee; LT for the left; both on separate lines if both knees were injected - Use either of two modifiers: JW if there's unused medication in a vial (wastage), or JZ if there's no unused medication. - Medicare and most payers reimburse per syringe under the (Medicare) Part B drug benefit Again, following the criteria set by your insurer is a must to avoid claim rejections.

## **Other similar codes** - **J7327** - Hyaluronan or derivative, monovisc, for intra-articular injection, per dose - **J7321** - Hyaluronan or derivative, hyalgan, supartz or visco-3, for intra-articular injection, per dose - **J7326** - Hyaluronan or derivative, gel-one, for intra-articular injection, per dose - **J7323** - Hyaluronan or derivative, euflexxa, for intra-articular injection, per dose - **J7322** - Hyaluronan or derivative, hymovis, for intra-articular injection, 1 mg