# 62284/Medicare help!!!!!!!!!!!



## Jennifer Moore (Jan 23, 2014)

We billed a myelogram to Medicare, CPT code 62284. Medicare denied our claim as duplicate to the radiologist?s claim. Medicare rep told me we need to rebill with a modifier to show that Dr was the surgeon and that it is the professional claim.  Does anyone know what modifier is correct? We used the "26" modifier on the 72295 code.

Thanks, 
Jennifer


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## lgeary (Jan 23, 2014)

you can check the Medicare fee schedule and it will show you what modifiers are payable with any CPT code.  Also the LCD will tell you.


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## mhstrauss (Jan 23, 2014)

Jennifer Moore said:


> We billed a myelogram to Medicare, CPT code 62284. Medicare denied our claim as duplicate to the radiologist?s claim. Medicare rep told me we need to rebill with a modifier to show that Dr was the surgeon and that it is the professional claim.  Does anyone know what modifier is correct? We used the "26" modifier on the 72295 code.
> 
> Thanks,
> Jennifer



62284 doesn't have a TC/26 breakdown, per the CMS RVU file.  Did your surgeon and the radiologist both submit 62284? Are they part of the same group?


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## Jennifer Moore (Jan 23, 2014)

We didn't put the 26/TC on the 62284 just the 72295, not sure no they are not part of the same practice. Thanks though


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## mhstrauss (Jan 23, 2014)

Jennifer Moore said:


> We didn't put the 26/TC on the 62284 just the 72295, not sure no they are not part of the same practice. Thanks though



If you are getting a duplicate denial, the radiologist must have also submitted the 62284, but didn't really have the right to, if your surgeon performed the injection procedure for the myelogram.  Is there a way to call the radiologist's office to find out exaclty what they billed?


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## Jennifer Moore (Jan 23, 2014)

Thank you so much for your feed back, I was under the same impression we have not had this issue with this code before until now.


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## dwaldman (Jan 23, 2014)

A myelogram is billed as such

62284 Injection procedure for myelography and/or computed tomography, spinal (other than C1-C2 and posterior fossa) 

with:

72265 Myelography, lumbosacral, radiological supervision and interpretation 

or

72255 Myelography, thoracic, radiological supervision and interpretation

or 

72245 Myelography, cervical, radiological supervision and interpretation 

or 

72270 Myelography, 2 or more regions (eg, lumbar/thoracic, cervical/thoracic, lumbar/cervical, lumbar/thoracic/cervical), radiological supervision and interpretation 

The 62284 and the appropriate supervision and interpretation code (72265, 72255, 72240, or 72270)  if the physician you are reporting for performed this portion of the test. Or did your physician perform the injection and the radiologist perform the final report of the images. The setting and the exact scenario is not clear. Typically if the radiologist is going to perform a myelogram he is going to do the injection and the supervision and interpretation. Maybe in the case you are a describing your physician performed the injection procedure and the supervision and interpretation. But a radiologist was also present during the case and did a report? Again what you are describing is unclear what transpired. Additionally, you indicate you are reporting 72295 Discography, lumbar, radiological supervision and interpretation. This would not be reported with the myelogram code, this might of just been a typo but if a discogram was performed the injection procedure code would be 62290 Injection procedure for discography, each level;  lumbar for the lumbar region.

I agree with Medicare customer service that the radiologist and your physician can not both report the same procedure code for the same procedure. If this was a split service such as your physician performed the injection portion and the radiologist performed the supervision and interpretation then each would report the respective code pertaining to what is performed. 

If you are billing for an ASC, for Medicare this service would not be covered due to the fact that diagnostic procedures such as discograms or myelograms are not reimbursed in an ASC for Medicare.

If you are billing for a Hospital, 62284 or 62290 payment would be packaged into the payment for the S and I code.

I would review with the physician who performed what service and was there duplication of performance of any of the procedure. I would also contact the radiologists office to see what portion they believe they billed. To narrow down the answer.


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## dwaldman (Jan 23, 2014)

72240 for the S & I of the cervical I accidently typed 72245


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