Neurosurgery Coding Alert

Question: How do we bill for epidurals? Is an epidurogram code 72275 (Epidurography, radiological supervision and interpretation)-26 (Professional component...) billable with epidurals? Is a component of 62311 (Injection[s], of diagnostic or therapeutic substance[s] [including anesthetic, antispasmodic, opioid, steroid, other solution], not including neurolytic substances, including needle or catheter placement, includes contrast for localization when performed, epidural or subarachnoid; lumbar or sacral [caudal])? Do we report 72275 only when an epidurogram is performed and recorded and a written radiological report is provided? We know that contrast was injected and it evenly spread from L3-4 posteriorly and anteriorly. The surgeon seems to be injecting contrast for a better view of where the injection is performed. Please help on the right codes.

New York Subscriber

Answer: The CPT® code 72275 differs from CPT® code 77003 (Fluoroscopic guidance and localization of needle or catheter tip for spine or paraspinous diagnostic or therapeutic injection procedures [epidural, or subarachnoid]) in that it represents a formal recorded and reported contrast study that includes fluoroscopy. You report epidurography when your surgeons documents that it is reasonable and medically necessary to perform a diagnostic study. You should not bill epidurography when the contrast injection is part of the fluoroscopic guidance and contrast injection to confirm correct needle placement that is integral to the epidural, transforaminal and intrathecal injections addressed in the policy. This is in accordance with the WPS Medicare LCD policy for epidurals.

Code 72275 is a component of Column 1 code 62311 but a modifier is allowed in order to differentiate between the services provided.

You may confirm the intent of the procedure. Confirm if the doctor was doing the epidural with fluoroscopy/contrast for low back pain or for a diagnostic procedure in order to better evaluate for understanding of underlying pathology of the pain.

Your clinician seems to have typically described the flow of contrast but this may not represent a formal contrast study with a myelogram report with specific diagnostic information that can be obtained from the report.

You may bill 62311 and 77003 for the description that you have shared.