# Mild procedure - One of the physicians



## mattrobin (Dec 9, 2009)

Good Morning,
One of the physicians I work for, has recently began performing the MILD (Minimally Invasive Lumbar Decompression) procedure.  
I have a question with regards to billing an Epidural Injection (62311) or Epidurography (72275) for his monitoring of this procedure???
Under the description of the Epidural Injection (62311) it states ("for either localization or epidurography")... Therefore, I'm leaning toward 62311...however, the only susbtance injected is contrast and saline.. and the report states "Epidurogram was seen"....
Does anyone have ANY experience with coding this procedure.. at this point...ANY/ ALL help would be appreciated. 
Thanks


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## RebeccaWoodward* (Dec 9, 2009)

We have performed these (MILD-63030); however, we haven't ever billed for 62311 in conjunction with 63030.  NCCI edits do not allow you to bill these two services together...even with a modifier.

http://www.cms.hhs.gov/NationalCorrectCodInitEd/NCCIEP/list.asp#TopOfPage


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## mattrobin (Dec 9, 2009)

*Mild procedure*

what do you find you, typically, bill with the MILD procedure... do your doc's use epidurography or fluoroscopy???
Thanks!


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## RebeccaWoodward* (Dec 9, 2009)

Typically, we only bill for the actual procedure and an additional level, if performed.  The AANS has stated that the fluro is not separately billable.


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## Vijay Chaudhary CPC (Jun 3, 2011)

There is no specific CPT code for the MILD (Minimally invasive lumbar decompression) procedure, the correct CPT code to use for this procedure is code 64999. This is unilateral procedure.

The procedure utilizes a contrast injection epidurogram, therefore appropriate injection code (like 62311) and 72275 would also be reported.
CMS created a HCPCS “C” code, C9729, which will be effective April 1, 2011 through June 30, 2011.  

Effective July 1, 2011, there is a CPT category III code that is applicable to this procedure:
0275T: Percutaneous laminotomy/laminectomy (intralaminar approach) for decompression of neural elements, (with or without ligamentous resection, discectomy, facetectomy and/or foraminotomy) any method under indirect image guidance (eg, fluoroscopic, CT), with or without the use of an endoscope, single or multiple levels, unilateral or bilateral; lumbar

Image-guided minimally invasive lumbar decompression describes a percutaneous procedure for decompression of the central spinal canal in patients with lumbar spinal stenosis. In this procedure, Through a small incision and using fluoroscopic guidance, the surgeon performs an epidurogram to identify the specific lumbar stenosis location, surgical tools are used under fluoroscopic guidance and small laminotomy and decompressive resection of the ligamentum flavum is performed to treat the patient's central canal spinal stenosis with additional contrast media added throughout the procedure to aid visualization of the decompression. The process is repeated on the opposite side for bilateral decompression of the central canal.. 

You might feel this procedure to be similar to the procedure described by code 63030, or 63056-63057.  But, these are not the correct codes for the MILD procedure as MILD procedure is needle-based, and the anatomic structures are not directly or endoscopically visualized and isn't intended for removal of disc material versus an open surgical or open with endoscopic-assisted approach in 63030.
______________________________
Vijay Chaudhary, CPC


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## RebeccaWoodward* (Jun 3, 2011)

I have to admit that I agree with your post.  When I originally posted this information, I had been misinformed.  Thanks for posting the correct information.


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## sadieandbrian (Jun 22, 2011)

We have been using 64999 and hadn't heard about C9729 or 0275T...do you know where we can get information on these 2 codes, I'm not finding anything on them. Should we be using these instead of 64999?


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## dwaldman (Jun 22, 2011)

"Effective July 1, 2011, HCPCS code C9729 will be deleted and replaced with new Category III CPT code 0275T. Category III CPT code 0275T will be added to the payable codes in the OPPS and assigned to the same status indicator and APC assignment as its predecessor HCPCS code C9729. Providers reporting the intralaminar decompression procedure should use CPT code 0275T beginning with services rendered on or after July 1, 2011. The table below summarizes the new coding information."

https://www.cms.gov/transmittals/downloads/R2234CP.pdf

For outpatient hospital reporting of this procedure, between April 1st  and June 30th, 
C9729 was set up for hospitals report the procedure so that the device kit and procedure would be accurately reimbursed. Starting July 1st, they will delete C9729 and start using 0275T. 

You have been correct in reporting 64999 for the physician side. Below is the update for July 1st for the physician side, you will find 0275T within the link. It has a payment indicator of C (carrier priced)

https://www.cms.gov/transmittals/downloads/R2223CP.pdf


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## jscholler (Jun 30, 2011)

I just want to clarify- only the facility can bill 0275T?  And the physician who performs the procedure will still have to bill 64999?


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## mattrobin (Jun 30, 2011)

How can you tell that 0275T is only billable for the facility? CAn you provide me a link, or website to support this?  I will have to show to our Dr's.. Thanks for your help


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## marvelh (Jun 30, 2011)

The new category III codes 

0274T Percutaneous laminotomy/laminectomy (intralaminar approach) for decompression of neural elements, (with or without ligamentous resection, discectomy, facetectomy and/or foraminotomy) any method under indirect image guidance (eg, fluoroscopic, CT), with or without the use of an endoscope, single or multiple levels, unilateral or bilateral; cervical or thoracic

0275T ...; lumbar

become effective tomorrow for all providers & faciliites unless directed specifically by a payer that they only update their category III codes annually at the beginning of the year.


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