Does Your Surgeon Write a Full Radiologic Report? Find Out
Published on Mon Jan 23, 2006
The answer depends on whose rules your payer follows When you-re reporting a procedure that requires a -formal radiologic report,- do you have what it takes to support that criterion? Read on as in-the-trenches coders weigh in with their opinions on correctly reporting
these procedures. Pay Attention to Arthrography and Epidurography
Orthopedic practitioners see this situation most often with arthrography and epidurography procedures. -Our physicians will sometimes perform an epidurogram just before an epidural injection, or an arthrogram just before an SI [sacroiliac] joint injection,- says Eileen Lorenco, RHIT, CS, CPC, a coder with Lahey Clinic in Burlington, Mass.
Your challenge is to determine whether the provider's documentation of the service qualifies as a formal radiology report. If it does, you can report more detailed--and often higher-valued--codes for the procedures; if it doesn-t, you-re relegated to more general--and possibly lower-paying--codes.
The coding options for these arthrography and epidurography procedures include:
- 73542 (Radiological examination, sacroiliac joint arthrography, radiological supervision and interpretation) for the SI joint arthrography.
- 72275 (Epidurography, radiological supervision and interpretation) for epidurography before an injection.
- 76005 (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) if documentation doesn't support using 73542 or 72275 for the procedure. The code descriptors don't mention formal radiologic reports, so beginning coders might not realize that extra documentation is necessary. This important bit of information actually comes after the code definitions in the parenthetical notes.
Arthrography tip-off: A note following code 73542 states, -For procedure, use 27096 (Injection procedure for sacroiliac joint, arthrography and/or anesthetic/steroid). If formal arthrography is not performed, recorded, and a formal radiologic report is not issued, use 76005 for fluoroscopic guidance for sacroiliac joint injections.-
Epidurography direction: The third note following 72275 states, -Use 72275 only when an epidurogram is performed, images documented, and a formal radiologic report is issued.-
Translate It to Your Bottom Line Reporting 76005 for these procedures if you-ve actually performed a procedure that warrants 73542 or 72275 nudges your bottom line down.
Dollar difference: The Medicare Fee Schedule includes a nominal difference in professional charges for fluoroscopy ($32.10) versus arthrography ($32.20). But the jump to a professional charge of $40.82 for epidurography can be a good incentive for some providers to improve their documentation habits.
-The difference in amounts is not staggering but could add up over time,- Lorenco says. -The real bottom line comes into play when you consider whether the physician is giving the correct documentation to support billing an epidurogram or arthrogram.-
Example: If an auditor discovers that a physician doesn't have the documentation to support billing arthrography or [...]
