Anesthesia Coding Alert

If you aren't familiar with the 70000 section of the CPT manual, you may be tempted to report an epidur-ogram for epidural steroid injection guidance, instead of the appropriate fluoroscopy code (77003). Stop denials in their tracks with the following accurate coding tips.

An epidurogram (72275, Epidurography, radiological supervision and interpretation) is a diagnostic tool, which means documentation should support medical necessity for the test and offer a description of the findings.

For example: Documentation should show the physician injected contrast into the epidural space under direct fluoroscopy for a diagnostic study. The report might indicate that he studied the flow, noting any obstructions of contrast in the space around the nerves to help him diagnose compressive lesions, narrowing and swelling around the nerve or nerve roots, or intervertebral disk herniations.

Remember: You may report 72275 only if the physician performs the separate diagnostic study, including a permanent radiologic image of the epidural space, with interpretation and written report. CPT states that 72275 includes 77003 (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), so you would not report them together, says Stacy Gregory, RCC, CPC, owner of Gregory Medical Consulting Services in Tacoma, Wash.

Bonus tip: Correct Coding Initiative (CCI) edits bundle 72275 into the epidural injections codes. You may override the edit with a modifier if your documentation supports the separate and distinct diagnostic epidurography procedure.

You need a written report signed by the interpreting physician to charge an epidurogram (72275).

The American College of Radiology (ACR) has very specific guidelines for documenting diagnostic image findings. For example, they advise physicians that "the report should include a description of the studies and/or procedures performed and any contrast media (including concentration, volume, and route of administration when applicable), medications, catheters, or devices used, if not recorded elsewhere."

To read the full text of the ACR's advice, visit http://www.acr.org/SecondaryMainMenuCategories/quality_ssafety/guidelines/dx/comm_diag_rad.aspx.