Ophthalmologist No. 1: Hey! Did you hear that Dextenza got a J-code?
Ophthalmologist No. 2: Wow! That’s terrific news.
Ophthalmologist No. 1: I know, right? Same thing for Omidria and Dexycu.
Ophthalmologist No. 2: That’s awesome. Say, remind me, what’s a J-code again?
Ophthalmologist No. 1: Um, I was kinda hoping you knew.
Ophthalmologist No. 2: Nope. I thought it was a new nickname for Jai Parekh. Sure sounds cool and important though.
Is it just me, or has there been a huge increase in the number of press releases we’ve been receiving about medicines and devices? We used to learn about new products at a big meeting, when a rep came by the office or the OR, or in the advertising pages of our trade publications like Ocular Surgery News. I was checking email in the OR on Tuesday and saw a Business Insider piece on the new Alcon PanOptix, my first clue that it had been approved and was available. Kinda like all the J-code announcements.
Darrell E. White
That’s your first clue about what a J-code is and why it matters, press releases in the business outlets. In short, a J-code is a unique identifier attached to a product that is used along with another service but is not bundled into the payment for that service. The best example for eye surgeons is mitomycin C used during glaucoma surgery. MMC received a J-code in 2004, I believe. When you do a trabeculectomy and use MMC, the cost is not covered as part of the procedure. Using J**** allows you to bill separately for MMC.
There’s the rub: A J-code only allows you to bill for the product. Assigning a J-code to a product like Omidria (phenylephrine 1% and ketorolac 0.3% intraocular solution, Omeros) will allow you to bill for its use, but the milestone of getting a permanent J-code has absolutely no bearing on whether or not you will actually be reimbursed for the cost of Omidria, Dextenza (dexamethasone ophthalmic insert 0.4 mg, Ocular Therapeutix), Dexycu (dexamethasone intraocular suspension 9%, EyePoint Pharmaceuticals) or other similar products. If you, like me, have an interest in using any of these (or MMC for that matter), this is a subtle but important distinction that has been all but lost in the press release frenzy.
Why is this here in a blog ostensibly dedicated to all things dry eye? As I see it, there are two reasons to use any of these products. First, they make your surgery and your patient’s postop recovery go more smoothly without the worries about said patient’s adherence to a drop regimen. Secondly, and more to the DED point, putting these medications into the eye or eluting them slowly over time (rather than bolusing by drop) is likely to be more kind to the ocular surface. Pretty soon I’m sure someone is going to publish a study showing low cystoid macular edema rates, minimal pain and negligible postop inflammation using a perioperative regimen that doesn’t require your patient to apply a single eye drop. You’ll just drop a couple of those J-codes on their insurance for whichever ones you use.
You may not get paid, but you will certainly be one of the cool kids.
Disclosure: White reports he is a consultant to Allergan, Shire, Sun, Kala, Ocular Science, Rendia, TearLab, Eyevance and Omeros; is a speaker for Shire, Allergan, Omeros and Sun; and has an ownership interest in Ocular Science and Eyevance.