Neurology & Pain Management Coding Alert

Stay tuned for details on how to keep your claims clean.

The Office of Inspector General (OIG) recently released its findings from its latest review of transforaminal epidural injections, and the news isn't good for pain management practitioners. The review showed that 34 percent of transforaminal epidural injection services that Medicare allowed in 2007 did not meet Medicare requirements. The mistakes resulted in approximately $45 million in improper payments.

Most mistakes stemmed from errors in documentation, medical necessity, or coding. CMS plans to educate providers on correct documentation and strengthen safeguards against improper payments (such as examining office-based injections or asking local contractors to develop local coverage determinations [LCDs] regarding transforaminal epidural injections).

Understand What You're Coding

Physicians often administer transforaminal epidurals laterally through the selected neuroforamen under fluoroscopy, says Joanne Mehmert, CPC, CCS-P, president of Joanne Mehmert and Associates in Kansas City, Mo. Once there, the physician performs an injection at the nerve root area to help relieve the patient's pain. The medication goes into the anterior epidural space, "bathing" a specific spinal nerve as it exits the spinal cord.

CPT includes four codes to represent transforaminal epidural injections, which you choose between based on the injection site and number of injections:

• 64479 -- Injection, anesthetic agent and/or steroid, transforaminal epidural; cervical or thoracic, single level
• +64480 -- ... cervical or thoracic, each additional level (List separately in addition to code for primary procedure)
• 64483 -- ... lumbar or sacral, single level
• +64484 -- ... lumbar or sacral, each additional level (List separately in addition to code for primary procedure).

Your role: If your providers administer transforaminal epidural injections, you must encourage thorough documentation and know how to correctly code the procedures. Watch for tips on correctly coding and documenting transforaminal epidural injections in future issues of Neurology and Pain Management Coding Alert. In the meantime, check out the complete report at www.oig.hhs.gov.