# charging for trays, needles , ect..



## krisfelty (Sep 22, 2008)

When doing in office (POS 11) epidurals and such, can you charge HCPS codes for the surgical tray and things used related to the procedure?


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## kevbshields (Sep 22, 2008)

As long as those items were purchased by the provider and there is no clinic "facility fee" (e.g., hospital-based clinic type).


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## krisfelty (Sep 22, 2008)

Thank you!


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## mbort (Sep 23, 2008)

If there is truly a procedure being performed, these items are included in the surgical package per the CPT code book, page 45 of the CPT 2008 Professional Edition, surgery guidelines, under the header "Materials Supplied by Physician". The supplies used must be "over and above" those usually used for a procedure in order to capture reimbursement.

The RVU's that are placed on each code are higher for some procedures done in the office setting to offset the cost of such items.

Hope this helps
Mary


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## meggz21 (Oct 8, 2008)

Where would it be documented that supplies were "over and above" the procedure? Should the physician document in the patient's record? I'm assuming that our physician's injections would include the trays, but he has written that these should be separate charges.


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## mbort (Oct 8, 2008)

I would think that for the types of cases you mention, that there will not be any over and above...but I suppose if he does an epidural that normally he uses two needles for, but for some reason had to use 4, then you could charge for the two extra needles.  (he can not count them if they are wasted because of contamination, dropping on floor, etc..he has to eat those..his fault)

Make sense?


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## meggz21 (Oct 8, 2008)

Yes, it does. I'm glad there are more experienced people on here to help. This physician gives Facet injections. I was having such a hard time finding a place that explained things further in writing. The CPT book was not too specific on this. Thanks.


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## aguelfi (Oct 9, 2008)

I don't bill for any trays used.  In the past they did and were never reimbursed.  My understanding is it's included.  I've never seen anything over and above being allowed.


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## meggz21 (Oct 9, 2008)

Thanks for the info. I'm fairly new at this. Do any of you who bill for pain management injections also do fluroscopy? I wasn't sure if I should be billing 77003 twice when the physician does two different injections in two diffeent areas or should it be billed once for that session? I couldn't find information anywhere on that.


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## MLS2 (Oct 9, 2008)

Per the 2008 Interventional Radiology Coder:
"Submit fluoro or CT guidance code only once per procedure regardless of how many levels are studied.  Verify with 3rd party payer policy on whether multiples of the guidance code may be used"


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## meggz21 (Oct 9, 2008)

So if he does a 27096 injection and a 64475 injection at the same visit, would that count as 2 different 77003 codes billed? This is where I'm a little confused.


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## mbort (Oct 10, 2008)

MLS2 said:


> Per the 2008 Interventional Radiology Coder:
> "Submit fluoro or CT guidance code only once per procedure regardless of how many levels are studied.  Verify with 3rd party payer policy on whether multiples of the guidance code may be used"




I disagree with the above statement, I believe that its misleading.  I agree with the "per level" but think that it should have further clarified that this can be coded "per region" and not stated that it could only be done once "per procedure.  Please see below from the CPT Assistant dated June 2008, pages 8-11:

*Code 77003

In contrast to code 77002, spine and paraspinous anatomic sites are specified in the descriptor of code77003, Fluoroscopic guidance and localization of needle or catheter tip for spine or paraspinous diagnostic or therapeutic injection procedures (epidural, transforaminal epidural, subarachnoid, paravertebral facet joint, paravertebral facet joint nerve or sacroiliac joint), including neurolytic agent destruction. Code 77003 describes fluoroscopic guidance of spinal or paraspinal injections, when fluoroscopy is performed for the purpose of guiding or localizing a needle or catheter tip for spinous or paraspinous injection procedures. Contrast may then be injected to determine whether the needle or catheter is in the correct place. When fluoroscopic guidance and localization for needle placement and injection is performed in conjunction with codes 64470-64476 and 64479-64484, code 77003 should be additionally reported. It would not be appropriate to report either code 76000 or 77002 in this circumstance.* *To further clarify, code 77003 is intended to be reported per spinal region (not per level).*
Since codes 62263, 62264, and 0027T include fluoroscopic guidance and localization, code 77003 is not reported in addition to these percutaneous or endoscopic lysis of epidural adhesion procedures.¿


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