Anesthesia Coding Alert

Question: How should I code an epidural steroid injection (ESI) performed with a myelogram?

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Answer: In an epidural injection, the physician places the needle in the epidural space (as the name suggests) above the dura; the physician punctures the dura and injects contrast into the intrathecal space during myelography. Because of this difference, a physician would not normally perform both procedures at the same level during the same visit.
 
First verify that the documentation supports both the epidural injection and myelography. Did the physician perform the procedures at two different levels (e.g., cervical and lumbar)? Or could he possibly have performed an ESI and an epidurography instead of a myelography?
 
Once you verify the procedure, you can code it accurately. Many physicians have incorrectly coded epidurographies as myelographies for years. CPT added 72275 (Epidurography, radiological supervision and interpretation) in an effort to correct this - and you should report it if the physician simply injects dye for needle placement during an epidural. However, Medicare bundles 72275 into most procedures because most physicians don't inject enough contrast or document a formal radiologic report that using 72275 requires.
 
If the physician did perform a myelogram, report the appropriate site from 72240-72270 (various locations for Myelography, radiological supervision and interpretation).

 - Answers to You Be the Coder and Reader Questions were reviewed by Trish Bukauskas-Vollmer, CPC, owner of TB Consulting in Myrtle Beach, S.C.