# arthrogram and epidurogram



## msmileyb (Nov 10, 2008)

I'm getting ready to defend myself to a physician regarding a difference in opinion on coding these procedures. Any suggestions?



Procedures Performed: Left L4-L5 arthrogram
                               Left L4-L5 transforaminal epidurogram, and caudal   
                               epidural

The patient was placed in a prone position and prepped and draped in the usual manner. A 25 guage Tuoy needle was inserted into the left L$-L% transoraminal space. A 1 ml onmipaque 300 injected. Arthrogram was performed. Once needle placement was confirmed, 1 ml lidocaine 1% ml celestone injected. Under fluoroscopy, a 22 guage tuoy needle was inserted into the caudal space. A 2 ml omnipaque 300 injected. Epidurogram was performed. Once needle placement was confirmed, 5 ml lidocaine 1% and 5 ml celestone injected.

Physician coded
62311 x 1 (caudal space) (bundled into 64483)
64483 mdf LT/59 (L4/L5 transforaminal space)
77003 (L4/L5) (bundled/inclusive into 77225)
77225 mdf/59  (bundled 62311/64483)

Medicare payor


There is no mention of that images were documented and a formal report done. (72275)


B]National Government Services LCD NY [/B]
An epidural block, bilateral sacroiliac joint injection, or lumbar sympathetic block should not be performed at the same spinal level on the same day as transforaminal epidural injection. Furthermore, *only one type of a block or injection should be performed in a given session so that effectiveness of its treatment can be assessed prior to attempting another type of a spinal block or injection. *


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