Neurology & Pain Management Coding Alert
Keep ESI Fluoro and 72275 Separate for Accurate Claims
Don't miss: Epidurography has strict documentation requirements If you aren't familiar with the 70000 section of the CPT manual, you may be tempted to report an epidurogram for epidural steroid injection guidance, instead of the appropriate fluoroscopy code (77003). Here's the Skinny on 72275 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 neurologist 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 nature of 72275. Dig Into Radiology Report Guidelines 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 surgeons 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 www.acr.org/SecondaryMainMenuCategories/quality_safety/guidelines/dx/comm_diag_rad.aspx.
Neurology & Pain Management Coding Alert
- Take Advantage of Reporting Fluoroscopy With ESIs -- Here's How
Payers hold the key to unlocking medical necessity for these injections It pays to reconsider [...] - Match ESI Codes to Proper Vertebrae at a Glance
Remember to watch for transforaminal or interlaminar approach You have a lot of elements to [...] - Keep ESI Fluoro and 72275 Separate for Accurate Claims
Don't miss: Epidurography has strict documentation requirements If you aren't familiar with the 70000 section [...] - Watch 99231 Claims or Risk Audit Troubles
Under-reporting 99232 and 99233 can raise red flags for payers Subsequent hospital care ranks among [...] - Improve Documentation With These 99231-99232 Guidelines
A thumbnail sketch can help prevent over- or under-reporting There are some "shorthand" cues neurologists [...] - You Be the Coder:
Separate E/M Visit from TPI?
Question: My doctor wants to start administering trigger point injections (TPIs). May I bill for [...] - Reader Questions:
Code Your Neurologist's Injections Correctly
Question: When should I report 90772 for injections the neurologist administers? California Subscriber Answer: Some [...] - Reader Questions:
Code Patient's Location, Not Doctor's
Question: I code for a neurologist who usually sees patients in his office. But one [...] - Reader Questions:
Avoid the ADD Label at Your Own Risk
Question: How should I code for a child who is inattentive or has trouble focusing [...]
