# 72275-59 in ASC ?



## abrodskycpc (Jun 15, 2015)

Hi all, 

I work for a billing company and we just took on a new pain management client. I am confused on the way they are billing 72275. 

We normally do not bill 72275 out in the facility setting. We have only been billing it with the professional charges with modifier 26. I?m noticing that the previous company was billing this code under the facility with a 59 and again under the professional with a 26. Can you provide any type of reasoning why they would be doing that? So far, I have not seen any payments or denials coming in for that code under the facility. 

Is there any reason why the previous place would have been doing it like this? 

Thanks!


----------



## dwaldman (Jun 15, 2015)

Below CPT 72275 for Medicare is found in addendum BB for ASCs. Addendum BB are services that are considered packaged and no separate payment is made.

CPT 72275 has a status indicator on the facility side for Medicare as N1

N1	Packaged service/item; no separate payment made.


Additionally below I copy and pasted the state operations manual describing the ASC as providing surgical services and certain services are considered ancillary.  Procedures such as discograms or myelograms are not covered in ASCs for Medicare because they have a primary diagnostic purpose. 

The concern that you would want to review is the procedure actually for the purpose of diagnostic epidurogram or is it more of the contrast is being injected with limited notation of the structures, but the primary purpose is therapeutic. Typically CPT 72275 is not going to be covered and the reason for the epidural is therapeutic. 

http://www.cms.gov/Medicare/Medicar...egulations-and-Notices-Items/CMS-1613-FC.html


Addendum BB -- Final ASC Covered Ancillary Services Integral to Covered Surgical Procedures for CY 2015 (Including Ancillary Services for Which Payment is Packaged)						
CPT codes and descriptions only are copyright 2014 American Medical Association.* All Rights Reserved.* Applicable FARS/DFARS Apply.  Dental codes (D codes) are copyright 2014 American Dental Association.* All Rights Reserved.						





Exclusive Provision of Limited Surgical Services  
*The ASC must offer only surgical services*.  Separate ancillary services that are integral to the surgical services, i.e., those furnished immediately before, during or immediately after a surgical procedure, may be provided.  The ASC may not, however, offer services unrelated to the surgeries it performs.  
What constitutes ?surgery??  
For the purposes of determining compliance with the ASC definition, CMS relies, with minor modification, upon the definition of surgery developed by the American College of Surgeons (www.facs.org/fellows_info/statements/st-11.html.)  Accordingly, the following definition is used to determine whether or not a procedure constitutes surgery:  
Surgery is performed for the purpose of structurally altering the human body by the incision or destruction of tissues and is part of the practice of medicine.  Surgery also is the diagnostic or therapeutic treatment of conditions or disease processes by any instruments causing localized alteration or transposition of live human tissue which include lasers, ultrasound, ionizing radiation, scalpels, probes, and needles.  The tissue can be cut, burned, vaporized, frozen, sutured, probed, or manipulated by closed reductions for major dislocations or fractures, or otherwise altered by mechanical, thermal, light-based, electromagnetic, or chemical means.  Injection of diagnostic or therapeutic substances into body cavities, internal organs, joints, sensory organs, and the central nervous system, is also considered to be surgery.  (This does not include the administration by nursing personnel of some injections, subcutaneous, intramuscular, and intravenous, when ordered by a physician.)  All of these surgical procedures are invasive, including those that are performed with lasers, and the risks of any surgical procedure are not eliminated by using a light knife or laser in place of a metal knife, or scalpel.


----------



## abrodskycpc (Jun 16, 2015)

Thank you!


----------

