Kenalog-40 Injection (triamcinolone acetonide injectable suspension, USP) is a synthetic glucocorticoid corticosteroid with anti-inflammatory action.
Each mL of the sterile aqueous suspension provides 40 mg triamcinolone acetonide, with 0.66% sodium chloride for isotonicity, 0.99% (w/v) benzyl alcohol as a preservative, 0.63% carboxymethylcellulose sodium, and 0.04% polysorbate 80. Sodium hydroxide or hydrochloric acid may be present to adjust pH to 5.0 to 7.5. At the time of manufacture, the air in the container is replaced by nitrogen.
Disputed Code : J3301
Maximum Allowable - $8.678
KENALOG® 40 mg/ml INJECTION (triamcinolone acetonide)
KENALOG-10 INJECTION is triamcinolone acetonide, a synthetic glucocorticoid corticosteroid with marked anti-inflammatory action, in a sterile aqueous suspension suitable for intradermal, intra-articular, and intra-bursal injection and for injection into tendon sheaths. This formulation is not for intravenous, intramuscular, intraocular, epidural or intrathecal
• Kenalog Injection is a steroid medicine, prescribed for many different conditions, including serious illnesses.
• You need to take it regularly to get the maximum benefit.
• Don’t stop taking this medicine without talking to your doctor – you may need to reduce the dose gradually.
• Kenalog Injection can cause side effects in some people (read Section 4 below). Some problems such as mood changes (feeling depressed or ‘high’), or stomach problems can happen straight away. If you feel unwell in any way, keep taking your medicine, but see your doctor straight away.
• Some side effects only happen after weeks or months. These include weakness of arms and legs, or developing a rounder face (read Section 4 for more information).
• If you take it for more than 3 weeks, you will get a blue ‘steroid card’: always keep it with you and show it to any doctor or nurse treating you.
• Keep away from people who have chicken pox or shingles, if you have never had them. They could affect you severely. If you do come into contact with chicken pox or shingles, see your doctor straight away.
INDICATIONS AND CLINICAL USE
Intra-articular: For intra-articular or intrabursal administration, and for injections into tendon sheaths, as adjunctive therapy for short-term administration in the following conditions: synovitis of osteoarthritis, rheumatoid arthritis, acute and subacute bursitis, acute gouty arthritis, epicondylitis, acute nonspecific tenosynovitis, and post-traumatic osteoarthritis.
Intradermal: Intralesional administration is indicated for the treatment of keloids, discoid lupus erythematosus, necrobiosis lipoidica diabeticorum, alopecia areata, and localized hypertrophic, infiltrated, inflammatory lesions of lichen planus, psoriatic plaques, granuloma annulare, and lichen simplex chronicus (neurodermatitis).
1. WHAT KENALOG INJECTION IS AND WHAT IT IS USED FOR
The name of this medicine is Kenalog Injection. Each injection contains triamcinolone acetonide 40mg/ml as the active ingredient. Triamcinolone acetonide belongs to a group of medicine called corticosteroids (steroids). Kenalog injection is for the treatment of joint pain, swelling and stiffness in inflammatory disorders such as rheumatoid arthritis.
It is also for the treatment of various allergic disorders including asthma, seasonal allergies, blood disorders, hormone problems, rheumatic fever, and problems associated with digestive system, kidneys, lungs or skin.
2. BEFORE YOU ARE GIVEN YOUR MEDICINE
Do not receive Kenalog Injection if:
• You have had an allergic reaction to a similar medicine or any of the ingredients in this medicine. See Section 6 for full list of ingredients
• You are suffering from an infection unless your doctor has also prescribed a treatment for the infection
Kenalog Injection is not recommended for children under 6 years.
You must tell your doctor if:
• You have had any recent infection [including tuberculosis (TB)]
• You have had recent bowel surgery
• You have, or have had a bowel disorder or stomach ulcer
• You have an infection or inflammation of the veins in your legs
• You have had any mental disorders or epilepsy
Because KENALOG-10 is a suspension, it should not be administered i.v.
Epidural and intrathecal administration of this product should not be used. Reports of serious medical events have been associated with epidural and intrathecal routes of administration. Cases of serious anaphylactic reactions and anaphylactic shock, including death, have been reported in individuals receiving triamcinolone acetonide injection, regardless of the route of administration.
KENALOG-10 is a long-acting preparation, and is not suitable for use in acute situations. Prolonged use of corticosteroids may produce posterior subcapsular cataracts or glaucoma with possible damage to the optic nerve. Prolonged use may also enhance the likelihood of secondary ocular infections
POSSIBLE SIDE EFFECTS
Like all medicines, this medicine can cause side effects, although not everybody gets them.
Serious effects: tell a doctor straight away
Steroids including Kenalog Injection can cause serious mental health problems. These are common in both adults and children. They can affect about 5 in every 100 people taking medicines like Kenalog Injection:
• Mood changes, mental disorders, feeling dependent on the medicine, trouble sleeping, fits or epilepsy, fainting and dizziness
• Feeling depressed, including thinking about suicide
• Feeling high (mania) or moods that go up and down
• Feeling anxious, having problems sleeping, difficulty in thinking or being confused and losing your memory
• Feeling, seeing or hearing things which do not exist. Having strange and frightening thoughts, changing how you act or having feelings of being alone
If you notice any of these problems talk to a doctor straight away.
Serious cases of anaphylactic reactions (i.e. a serious allergic reaction) and anaphylactic shock including death have been reported. If you notice any of the following, contact your doctor immediately:
• Swelling of the face, lips or throat
• Breathing difficulties
• Skin itching, redness or a rash
• As these may be signs of an allergic reaction
Common side effects (may affect up to 1 in 10 people)
• Increased risk of infection
• Injection site reactions
• Joint pain
• You have had any kidney, liver or thyroid (gland in the neck) problems as the dose of Kenalog may need to be adjusted
• You have recently suffered from any form of cancer
• You have thin or brittle bones (osteoporosis)
• You have myasthenia gravis (a disease which causes weak muscles)
• You have high blood pressure or heart failure
• You or someone in your family has glaucoma (increased pressure in your eyes).
• You are diabetic as your insulin dose may need to be changed
Check with your doctor first:
• If you have ever had severe depression or manic-depression (bipolar disorder). This includes having had depression before while taking steroid medicines like Kenalog Injection.
• If any of your close family has had these illnesses.
If either of these applies to you, talk to a doctor before taking Kenalog Injection.
How to bill J3301 with correct units
J3301 triamcinolone acetonide, (Kenalog-10, Kenalog-40) per 10 mg
Your bottle says Kenalog 40 =40 mg/ml
If you use 0.25 cc 10 mg/40 mg = 1 Unit
If you use 0.5 cc 20 mg/40 mg = 2 Units
If you use 0.75 cc 30 mg/40 mg = 3 Units
If you use 1.0 cc 40 mg/40 mg = 4 Units
How to calculate the NDC units?
Billing the correct number of NDC units for the corresponding HCPCS/CPT codes on your claims is essential. There are two ways to calculate NDC units:
Option 1 – Use Our Online NDC Units Calculator Tool
Contracted providers may access the online NDC Units Calculator Tool for assistance with converting HCPCS or CPT units to NDC units. This user friendly tool is available to payer contracted providers at no cost.
Option 2 – Calculate the NDC Units Manually
If you prefer to calculate the NDC units manually, there are several steps you will need to take. Here is a sample manual calculation
[Ciprofloxacin IV, NDC 00409-4765-86, 1200 MG (1 day supply)]:
The amount of the drug to be billed is 1200 MG, which is equal to 6 HCPCS/CPT units.
The NDC unit of measure for a liquid, solution or suspension is ML; therefore, the amount billed must be converted from MG to ML.
According to the NDC description for NDC 00409-4765-86, there are 200 MG of ciprofloxacin in 20 ML of solution (200 MG/20 ML).
Take the amount to be billed (1200 MG) divided by the number of MG in the NDC description (200 MG). 1200 ÷ 200 = 6
Multiply the result (6) by the number of ML in the NDC description (20 ML) to arrive at the correct number of NDC units to be billed on the claim (120). 6 x 20 ML = 120
When submitting NDCs on my claim, what other information need to include?
When submitting NDCs on professional/ancillary electronic (ANSI 837P) or paper (CMS-1500) claims, you must also include the following related information in order for your claim to be accepted and reviewed for possible benefits at the NDC level: How to submit J Codes with correct Unit.
o The applicable HCPCS or CPT code
o Number of HCPCS/CPT units
o NDC qualifier (N4)
o NDC unit of measure (UN, ML, GR, F2)
o Number of NDC units (up to three decimal places)
Note: As a reminder, you also must include your billable charge.
Where to enter NDC data on electronic claim (ANSI 5010 837P) transactions?
Here are general guidelines for including NDC data in an electronic claim:
Product ID Qualifier
Enter N4 in this field
National Drug Code
Enter the 11-digit NDC billing format
assigned to the drug administered
National Drug Unit Count
Enter the quantity (number of NDC units)
Unit or Basis for Measurement
Enter the NDC unit of measure for the
prescription drug given (UN, ML, GR, or F2)