Neurology & Pain Management Coding Alert

Question: I get confused about which services we can bill along with a transforaminal epidural injection. Are 64479, 72275, 72275-26, and 72275-TC allowed together?

Texas Subscriber

Answer: In this situation, you should only submit 64479 (Injection[s], anesthetic agent and/or steroid, transforaminal epidural, with imaging guidance [fluoroscopy or CT]; cervical or thoracic, single level). You should only report 72275 (Epidurography, radiological supervision and interpretation) when your physician performs a separate and distinct epidurogram diagnostic study, documents images in multiple planes, and issues a formal radiologic report. CPT® has indicated that “the data obtained from the diagnostic epidurography should influence and improve patient treatment options and contribute new information to that already obtained from other spinal imaging procedures commonly used, such as magnetic resonance imaging and computed tomography with myelography. Epidurography should not be used routinely for localization with the performance of most therapeutic spinal injection procedures.” The injection of contrast does not constitute a diagnostic study but instead is frequently performed as part of verifying the placement of the needle for the epidural injection. If your physician didn’t complete the requirements of 72275, you don’t bill it.