Anesthesia Coding Alert

Before an anesthesiologist injects a spinal drug, he or she may perform a separate dye injection to check the spread of dye to be sure the correct areas will be affected by the agent. This is especially true when the physician is preparing to perform any steroid epidural injection for pain management.

And although such injections are a fairly common practice, some coding practitioners arent sure how to handle it because no CPT code matches it exactly. Correctly coding for this procedure involves coding for accuracy and not just optimal reimbursement.

Will Donald, business manager at Pain Management Associates in Little Silver, NJ, recounts some history: Whenever we used fluoroscopy in a spinal, we used to code the dye injection as a myelogram injection (code 62284, injection procedure for myelography and/or computerized axial tomography, spinal [other than C1-C2 and posterior fossa]). A representative at one of our insurance carriers told us to code the procedure this way for maximum reimbursement, so thats what we did. But we started having problems with using that code because some carriers wouldnt pay for it if we couldnt prove that a myelogram had been done. (And of course, because the purpose of the dye injections was merely to ascertain the area to which the dye would spread, no myelogram was actually done).

Coding for Accuracy, Not Just
for Reimbursement,

Codes now being used for spinal dye injections include:

62275*Injection of diagnostic or therapeutic anesthetic or antispasmodic substance; epidural, cervical or thoracic, single. Filing for a procedure with this code would be 62298* (for the injection of an epidural steroid in the cervical region) 62275* (for the injection of the diagnostic substance) 76000-26 (for the interpretation of fluoroscopic guidance).

62278*Injection of diagnostic or therapeutic anesthetic or antispasmodic substance; epidural, lumbar or caudal, single. Filing for a procedure with this code would be 62289* (for the injection of an epidural steroid in the lumbar region) 62278* (for the injection of the diagnostic substance) 76000-26 (for the interpretation of fluoroscopic guidance).

Another line of reasoning is followed by Gloria Court, an anesthesia coder with Medical Billing Services in Bellaire, TX. We bill the spinal dye as a cervical or lumbar injection because those codes are closer in relative value units (RVUs) to the procedure than the myelogram code is. Since theres not a CPT code that matches the procedure exactly, we think its more appropriate to base the billing code on RVUs. The RVUs associated with a mylegram are over twice the amount of the RVUs for an epidural injection. The spinal dye procedure itself is closer to an epidural injection, so using 62275* or 62278* seems more legitimate.

Carriers May or May Not Care
About the Code

Cathi Turknett, office coordinator with Carolina Pain Consultants in Statesville, NC, says that although billing the spinal dye procedure as an epidural injection may be more appropriate, some carriers will still pay for the procedure if it is coded as a myelogram. Part of it depends on how the person handling the claim at the insurance carriers office interprets the CPT code, she says. If they interpret the code to mean merely injection of dye, then theyll approve having it coded as a myelogram. If the code is interpreted to mean injection of dye for the sole purpose of myelogram, then the carrier will require documentation of the myelogram before theyll pay for it.

Donalds practice began using codes 62275* and 62278* in July, so some claims are still being reimbursed. But so far everything seems to be going through the system pretty well. Medicare approves of using these codes for the procedure, and will hopefully include codes specific for it in updated manuals. In the meantime, sometimes we even make copies of Medicares policies to send in with the claims. Were not having any more denials than when we were using 62284*, and may even be getting fewer. It will be interesting to see how the claims are processed as we work with different carriers.