Anesthesia Coding Alert

Question: What is the difference between CPT 72275 and 76005? My pain management physician wants to bill 72275 for the single epidural injection (his office owns the machine), and I've been billing the professional and technical components for 76005. But he insists that both procedures are the same, and wants to bill 72275-26 and 72275-TC. How should I explain the difference?

New Jersey Subscriber
 
Answer: The first difference lies in the descriptors, which show that 76005 is for fluoroscopy only, while 72275 is for epidurography and includes fluoroscopy. Code 72275 (Epidurography, radiological supervision and interpretation) includes supervision and interpretation (S&I), which means that the interpreting physician must dictate and sign a written report. CPT's radiology section includes more details about this code's S&I requirements.

And, a note below 72275's descriptor states that it includes fluoroscopic guidance (76005, 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). This makes sense because the physician uses the same insertion site for the fluoroscopic guidance and the epidurography. 

Many radiology codes, such as 72275, have three coding options depending on the situation. If the physician owns the equipment, only bill the procedure code; if the hospital owns the equipment, append modifier -TC (Technical component) to the procedure code; if the physician only provides S&I, append modifier -26 (Professional component) to the procedure code. Because the physician in your example owns the equipment, report 72275 for the procedure, but do not add any modifiers.