The following codes may be appropriate when billing for ZILRETTA™ (triamcinolone acetonide extended-release injectable suspension) and related service. This information is for reference only. Please contact your patient’s health plan or work with FlexForward℠ to confirm coding for a specific plan.
|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|
|Hospital outpatient (Medicare)|
|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|
|RT||Right side (used to identify procedures performed on the right side of the body||Used to report injections in the right knee only|
|LT||Left side (used to identify procedures performed on the left side of the body)||Used to report injections in the left knee only|
|50||Bilateral procedure||Used to report injections in both knees|
|Hospital Revenue Codes (for hospital use only)6|
|0636||Drugs requiring detailed coding|
|0510||Clinic visit (general)|
When using Not-Otherwise-Classified (NOC) code J3490 (or C9399 for Medicare) to report the use of ZILRETTA, health plans may require additional information, including the name of the drug (both brand and generic), National Drug Code (NDC) number, strength of drug administered, and dose.
|Sample Product-Identifying Information|
|Drug name||ZILRETTA (triamcinolone acetonide extended-release injectable suspension)|
|Drug strength and dose||32 mg triamcinolone acetonide ER|
|Route of administration||Intra-articular injection|
- 11-digit NDC is derived from the 10-digit code for the ZILRETTA kit (70801-003-01). Keep in mind that many health plans require use of the 11-digit code.
CPT=Current Procedural Terminology; ER=extended release; HCPCS=Healthcare Common Procedure Coding System; ICD-10=International Classification of Diseases, 10th Revision.