2025 HCPCS code J1130
Injection, diclofenac sodium, 0.5 mg
Modifiers can be applied to J1130 to indicate specific circumstances. Refer to the modifier list and payer guidelines for correct usage.
Medical necessity for diclofenac sodium must be supported by documentation of the patient's severe pain and the clinical rationale for its use. Payer-specific guidelines for medical necessity should be consulted.
This code represents only the drug component, not the administration. Reporting this code denotes the provision of 0.5 mg of diclofenac sodium for injection.
In simple words: This code represents an injection of diclofenac, a medicine for pain relief, given directly into a muscle or vein. It's used to treat severe pain from conditions like kidney stones, arthritis, back pain, gout, and fractures in adults and older children. Each unit of the code equals 0.5 milligrams of the medication.
Diclofenac sodium is injected into a muscle (intramuscularly) or vein (intravenously) to treat severe pain caused by conditions such as kidney stones, rheumatoid arthritis, osteoarthritis, back pain, gout, and fractures in adults and children over 12 years of age. Each unit of J1130 represents 0.5 mg of diclofenac sodium.
Example 1: A 15-year-old patient presents to the emergency department with severe pain due to a kidney stone. Diclofenac sodium is administered intravenously for pain relief. J1130 is reported for the drug., A 45-year-old patient with rheumatoid arthritis experiences a flare-up with severe joint pain. They receive an intramuscular injection of diclofenac sodium. J1130 is reported., A 60-year-old patient with a fractured femur experiences severe pain during transport. They are given an intravenous injection of diclofenac sodium for pain management. J1130 is used to bill for the medication.
Documentation should include the diagnosis necessitating the use of diclofenac sodium, the dosage administered (0.5 mg units), the route of administration (intramuscular or intravenous), and the patient's response to the medication.
** Although the code description mentions its use in children over 12, always consult current prescribing information and clinical guidelines for appropriate usage in pediatric populations. Note that as of December 10, 2024, this code is deleted and should not be used for billing. Refer to updated coding guidelines and resources for current billing practices.
- Specialties:Pain Management, Emergency Medicine, Rheumatology, Orthopedics
- Place of Service: "Office", "Home", "Outpatient Hospital", "Inpatient Hospital", "Emergency Room - Hospital", "Ambulatory Surgical Center", "Independent Clinic", "Federally Qualified Health Center"