NEW CODE FOR VISCO-3

VISCO-3™ is a solution made of highly purified, sodium hyaluronate (hyaluronan). It is used for the treatment of pain in osteoarthritis of the knee in patients who have failed to get adequate relief from simple painkillers or from exercise and physical therapy.

Treatment regimen of VISCO-3:

A treatment regimen of VISCO-3 consists of injections of 2.5 mL of VISCO-3 administered once per week for three weeks for a total of three injections. One ml of VISCO-3 contains 10 mg of sodium hyaluronate (hyaluronan) dissolved in a physiological saline (1.0% solution), and each injection contains 2.5mL of volume.

Code history of VISCO-3

In 2018, VISCO-3 was assigned the code J7321. This code includes hyalgan, supartz or visco-3 in its code description. Though the composition of VISCO-3 and SUPARTZ FX were the same, FDA approved SUPARTZ FX as a 5 Injection regimen compared to VISCO-3 as a three injection treatment series. Therefore requests were made to develop a new code to represent VISCO-3 separately. Code J7321 is revised in its description to delete VISCO-3 and new code J7333 is established to report VISCO-3 separately.

2019 code description:

J7321 Hyaluronan or derivative, hyalgan, supartz or visco-3, for intra-articular injection, per dose

Long description change effective 07/01/2020:

J7321: Hyaluronan or derivative, hyalgan or supartz, for intra-articular injection, per dose

New code effective 07/01/2020:

J7333: Hyaluronan or derivative, VISCO-3, for intraarticular injection, per dose

Coding and Billing for VISCO-3:

1. Prior authorization/pre-determination is suggested prior to administration of VISCO-3 Sodium Hyaluronate. The payer will want to review the product specifically, dosage, route of administration and medical necessity.

2. Both the HCPCS code (J7333) and the NDC (National drug code) should be reflected on the CMS-1500 claim form.

3. The following qualifiers are to be used when entering supplemental information for the billing of VISCO-3 Sodium Hyaluronate.

  • N4 National Drug Codes (NDC)
  • ML Milliliter

4. Note the below key points when entering the supplemental information:

  • Begin at 24A on the CMS-1500 claim form by entering the qualifier and then the information.
  • Do not enter a space between the qualifier and the number/code/information.
  • Do not enter hyphens or spaces within the number/code.
  • Information needs to be added in the order as: qualifier, NDC code, one space, unit/basis of measurement qualifier, quantity.
  • The number of digits for the quantity is limited to eight digits before the decimal and three digits after the decimal. If entering a whole number, do not use a decimal.
  • Do not use commas.

Sample claim form:

CPT codes:

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 reporting

New code for VISCO-3

J7333: Hyaluronan or derivative, VISCO-3, for intraarticular injection, per dose

NDC code:

87541-0301-31: VISCO-3 Sodium Hyaluronate

Billing subsequent injections in a series (EJ modifier)

A series is defined as a set of injections for each joint and each treatment. The EJ modifier is required by Medicare for subsequent claims for a defined course of therapy (e.g., sodium hyaluronate, infliximab). This modifier is not to be used with the first injection of each series. Being an informational modifier, it should be submitted in the last modifier position on the CMS-1500 form.

Happy learning! Happy Coding!

Resources:

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