Coding and Billing | ZILRETTA HCP J-Code

Permanent, Product-specific HCPCS Code¹
	Description	Sites of Care	Billable Units
J3304	Injection, triamcinolone acetonide, preservative-free, extended-release, microsphere formulation, 1 mg	Physician office or hospital outpatient for dates of service on or after January 1, 2019	Bill 32 units per injection (1 unit per mg)*

Permanent, Product-specific HCPCS Code¹

Description

Sites of Care

Billable Units

J3304

Injection, triamcinolone acetonide, preservative-free, extended-release, microsphere formulation, 1 mg

Physician office or hospital outpatient for dates of service on or after January 1, 2019

Bill 32 units per injection (1 unit per mg)*

ICD-10-CM Codes²
M17.0	Bilateral primary osteoarthritis of knee
M17.11	Unilateral primary osteoarthritis, right knee
M17.12	Unilateral primary osteoarthritis, left knee
M17.2	Bilateral post-traumatic osteoarthritis of knee
M17.31	Unilateral post-traumatic osteoarthritis, right knee
M17.32	Unilateral post-traumatic osteoarthritis, left knee
M17.4	Other bilateral secondary osteoarthritis of knee
M17.5	Other unilateral secondary osteoarthritis of knee

ICD-10-CM Codes²

M17.0

Bilateral primary osteoarthritis of knee

M17.11

Unilateral primary osteoarthritis, right knee

M17.12

Unilateral primary osteoarthritis, left knee

M17.2

Bilateral post-traumatic osteoarthritis of knee

M17.31

Unilateral post-traumatic osteoarthritis, right knee

M17.32

Unilateral post-traumatic osteoarthritis, left knee

M17.4

Other bilateral secondary osteoarthritis of knee

M17.5

Other unilateral secondary osteoarthritis of knee

CPT Code³
20610	Arthrocentesis, aspiration and/or injection, major joint or bursa (eg, shoulder, hip, knee, subacromial bursa); without ultrasound guidance	Used to report knee injections without ultrasound guidance

CPT Code³

20610

Arthrocentesis, aspiration and/or injection, major joint or bursa (eg, shoulder, hip, knee, subacromial bursa); without ultrasound guidance

Used to report knee injections without ultrasound guidance

Modifiers³
RT	Right side (used to identify procedures performed on the right side of the body)	Used to report injection in the right knee only
LT	Left side (used to identify procedures performed on the left side of the body)	Used to report injection in the left knee only
50	Bilateral procedure	Used to report injection in both knees

Modifiers³

Right side (used to identify procedures performed on the right side of the body)

Used to report injection in the right knee only

Left side (used to identify procedures performed on the left side of the body)

Used to report injection in the left knee only

Bilateral procedure

Used to report injection in both knees

Hospital Revenue Codes (for hospital use only)⁴
0636	Drugs requiring detailed coding
0510	Clinic visit (general)

Hospital Revenue Codes (for hospital use only)⁴

0636

Drugs requiring detailed coding

0510

Clinic visit (general)

Product Information for ZILRETTA
11-digit NDC^†	65250-0003-01
Drug strength and dose	32 mg triamcinolone acetonide ER

Product Information for ZILRETTA

11-digit NDC^†

65250-0003-01

Drug strength and dose

32 mg triamcinolone acetonide ER

Indication and Important Safety Information

Indication

ZILRETTA® (triamcinolone acetonide extended-release injectable suspension) is indicated as an intra-articular injection for the management of osteoarthritis pain of the knee.

Limitation of Use: The efficacy and safety of repeat administration of ZILRETTA have not been demonstrated.

Contraindication

ZILRETTA is contraindicated in patients who are hypersensitive to triamcinolone acetonide, corticosteroids, or any components of the product.

Warnings and Precautions

Intra-articular Use Only: ZILRETTA has not been evaluated and should not be administered by epidural, intrathecal, intravenous, intraocular, intramuscular, intradermal, or subcutaneous routes. Serious events have been reported with epidural and intrathecal administration of corticosteroids and none are approved for this use. ZILRETTA should not be considered safe for epidural or intrathecal administration.
Hypersensitivity Reactions: Rare instances of anaphylaxis, including serious cases, have occurred in patients with hypersensitivity to corticosteroids.
Joint Infection and Damage: A marked increase in pain accompanied by local swelling, restriction of joint motion, fever, and malaise are suggestive of septic arthritis. Examine joint fluid to exclude a septic process. If diagnosis is confirmed, institute appropriate antimicrobial therapy. Avoid injecting corticosteroids into a previously infected or unstable joint. Intra-articular administration may result in damage to joint tissues.
Increased Risk of Infections: Infection with any pathogen in any location of the body may be associated with corticosteroid use. Corticosteroids may increase the susceptibility to new infection and decrease resistance and the ability to localize infection.
Alterations in Endocrine Function: Corticosteroids can produce reversible hypothalamic-pituitary-adrenal axis suppression, with potential for adrenal insufficiency after withdrawal of treatment, which may persist for months. In situations of stress during that period, institute corticosteroid replacement therapy.
Cardiovascular and Renal Effects: Corticosteroids can cause blood pressure elevation, salt and water retention, and increased potassium excretion. Monitor patients with congestive heart failure, hypertension, and renal insufficiency for edema, weight gain, and electrolyte imbalance. Dietary salt restriction and potassium supplementation may be needed.
Increased Intraocular Pressure: Corticosteroid use may be associated with increased intraocular pressure. Monitor patients with elevated intraocular pressure for potential treatment adjustment.
Gastrointestinal Perforation: Corticosteroid administration may increase risk of gastrointestinal perforation in patients with certain GI disorders and fresh intestinal anastomoses. Avoid corticosteroids in these patients.
Alterations in Bone Density: Corticosteroids decrease bone formation and increase bone resorption. Special consideration should be given to patients with or at increased risk of osteoporosis prior to treatment.
Behavior and Mood Disturbances: Corticosteroids may cause adverse psychiatric reactions. Prior to treatment, special consideration should be given to patients with previous or current emotional instability or psychiatric illness. Advise patients to immediately report any behavior or mood disturbances.

Adverse Reactions

The most commonly reported adverse reactions (incidence ≥1%) in clinical studies included sinusitis, cough, and contusions.

Please see full Prescribing Information.

References:

2019 table of drugs. Centers for Medicare & Medicaid Services website. https://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets/Downloads/2019-Table-of-Drugs.pdf. Updated October 26, 2018. Accessed November 6, 2018.
2018 ICD-10-CM and GEMs. 2018 Code Descriptions in Tabular Order. Centers for Medicare & Medicaid Services website. https://www.cms.gov/Medicare/Coding/ICD10/2018-ICD-10-CM-and-GEMs.html. Updated August 11, 2017. Accessed May 3, 2018.
CPT code 20610 - 20605, 20600, 20611 - ICD - billing guide. Radiology Billing website. http://www.radiologybillingcoding.com/2016/08/cpt-code-20610-billing-guide.html. Updated August 30, 2016. Accessed November 13, 2018.
Revenue codes. Noridian Healthcare Solutions website. https://med.noridianmedicare.com/web/jea/ topics/claim-submission/revenue-codes. Updated September 26, 2018. Accessed November 13, 2018.

Coding information for ZILRETTA