General Surgery Coding Alert

Question: What is the appropriate way to code for the verification of the location of the tip of an epidural catheter that has been placed in the patients epidural space in the spine? Dye on contrast was injected to locate the tip, and the procedure is described as an epidurogram.

Audrey Adams,
Princeton Reimbursement Group, MN

Answer: The epidurogram should be billed using code 62278* (injection of diagnostic or therapeutic anesthetic or antispasmodic substance [including narcotics]; epidural, lumbar or caudal, single), while the associated radiological supervision and interpretation (S&I) code would be 76000 (fluoroscopy [separate procedure], up to one hour physician time, other than 71023 or 71034 [e.g., cardiac fluoroscopy]), says Kathleen Mueller, RN, CPC, CCS-P, a reimbursement specialist in the office of Allan L. Lieffer, MD, a general surgeon in Chester, IL. According to Mueller, a separate radiology report needs to be dictated by the surgeon in order to be reimbursed for the S&I. She adds that according to Medicare guidelines, the physician who guides further treatment of the patient after the procedure should be the one who bills for it.

Increasingly, patients are receiving continuous epidurals after surgery, but this particular epidural is diagnostic and therefore single, Mueller says. Precisely because it is a diagnostic test, she notes, it is reimbursable; normally, pain management procedures by the surgeon are included in the primary procedures global package.

So if the epidurogram was performed after a surgical procedure, a -79 modifier (unrelated procedure or service by the same physician during the postoperative period) would need to be added to the 62278*, along with the associated ICD-9 code. If the procedure was performed due to a complication, modifier -78 (return to the operating room for a related procedure during the postoperative period) would be appended.

In other words, if the surgeon put the catheter in and performed a major procedure, then modifier -78 would be appropriate, as this would be considered a complication. If an anesthesiologist placed the catheter and maintained it, and a problem ensued, the surgeon would code the procedure 62278*-79, Mueller says.