Orthopedic Coding Alert

Question: May I report CPT^® 77003 and 72285 together for the same service? A coworker told me that I should override the edit because it has a “1” modifier indicator.

Washington, D.C., Subscriber

Answer: No, you should never override an edit just because you can.

Correct Coding Initiative (CCI) edits bundle 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) into 72285 (Discography, cervical or thoracic, radiological supervision and interpretation).

You should override the edit only if you meet the very strict guidelines for doing so. For example, an article on the CMS Web site states that you may override an edit with modifier 59 (Distinct procedural service) “if the two procedures/surgeries are performed at separate anatomic sites or at separate patient encounters on the same date of service.” For CCI, “the definition of different anatomic sites includes different organs or different lesions in the same organ. However, it does not include treatment of contiguous structures of the same organ.” (Find the article at http://www.cms.hhs.gov/NationalCorrectCodInitEd/Downloads/modifier59.pdf.)

Don’t miss: You may report the injection procedure separately with a code such as 62290 (Injection procedure for discography, each level; lumbar).