Radiology Coding Alert

Additions and revisions to CPT Codes 2000 codes will provide radiologists with appropriate levels of reimbursement for a range of spinal injection procedures. The changes make a lot of sense and have brought a greater degree of order to these codes, comments David Quintana, director of coding and compliance for Healthcare Management Partners, LLC, in Irvine, Calif., which provides billing and management support to more than 50 radiology, radiation oncology, imaging, surgery and pain management physicians in Southern California. In the past, the codes didnt truly reflect how most practices operated. The reorganization and addition of codes have been very helpful.

Primary changes are three new radiologic supervision and interpretation codes:

CPT 72275 (epidurography, radiological supervision and interpretation)

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)

73542 (radiological examination, sacroiliac joint arthrography, radiological supervision and interpretation)

Each of these codes more accurately reflects the amount of time and effort radiologists expend during procedures performed to diagnose and treat back pain, Quintana explains. Examples of diagnostic codes that support medical necessity for these procedures include sciatica (724.3) and intervertebral disc disorders (722.0722.2, 722.71722.73).

Imaging Associated With Needle Placement

Code 72275 represents a significant step forward for radiologists, says Jon Shanser, MD, radiologist associated with the San Francisco Spine Center at St. Francis Memorial Hospital. For the first time, it gives us a proper way to be reimbursed for epidurographythe imaging, supervision and interpretation associated with spinal injections.

As with interventional radiology procedures, spinal injections often require that the radiologist perform the procedure, as well as do the imaging. With an epidural injection, we first insert the needle and then take images of the needle tip in the epidural space before we inject the steroid and/or anesthetic agent. Obviously, one needs to be sure the needle is positioned correctly.

In the past, there was no code available to bill for the films and their interpretation, so we were not properly reimbursed for these services, Shanser explains.

Some radiology practices compensated for the lack of an imaging code, he notes, by taking and billing two views of the spineanteroposterior (AP) and lateral (codes 72040radiologic examination, spine, cervical; anteroposterior and lateral; 72070radiologic examination, spine; thoracic, anteroposterior and lateral; or 72100radiologic examination, spine, lumbosacral; anteroposterior and lateral). This helped reimbursement, but it wasnt ideal, Shanser says. Obviously, the new code fills a real void in this area.

72275 in Conjunction With Related Surgical Codes

Code 72275 can be assigned in conjunction with three sets of surgical injection codes that also have been revised.

A. 62280*-62282*. Code 62280* describes the injection/infusion of neurolytic substance (e.g., alcohol, phenol, iced saline solutions), with or without other therapeutic substance; subarachnoid. Code 62281* describes an epidural, at the cervical or thoracic level, and 62282* describes the epidural at the lumbar or sacral (caudal) level. The revised description has added infusion and with or without other therapeutic substances to previous descriptors.

B. Codes 62310-62319. These four new codes represent a consolidation of 10 codes that had been previously used to describe needle placement.

62310 (injection, single [not via indwelling catheter], not including neurolytic substances, with or without contrast [for either localization or epidurography], of diagnostic or therapeutic substance[s] [including anesthetic, antispasmodic, opioid, steroid, other solution], epidural or subarachnoid; cervical or thoracic) replaces 62274, 62275 and 62288.

62311 (lumbar, sacral [caudal]) replaces 62278 and 62289. It should also be used for lumbar procedures that required 62274 and 62288 in 1999.

62318 (injection, including catheter placement, continuous infusion or intermittent bolus, not including neurolytic substances, with or without contrast [for either localization or epidurography], of diagnostic or therapeutic substance[s] [including anesthetic, antispasmodic, opioid, steroid, other solution], epidural or subarachnoid; cervical or thoracic) replaces 62276 and 62277

62319 (lumbar, sacral [caudal]) replaces 62279 and should be reported for lumbar procedures that previously were coded with 62276 and 62277.

C. 64479-64484. This is a new set of codes, used to describe transforaminal epidural injection of anesthetic agents and/or steroids.

64479 (injection, anesthetic agent and/or steroid, transforaminal epidural; cervical or thoracic, single level).

64480 is the add-on code that would be assigned for each additional cervical or thoracic level. Code 64480 should be listed separately, in addition to primary procedure code 64479.

64483 describes a transforaminal epidural of the lumbar or sacral, single level.

64484 is the add-on code to describe these injections at each additional level.

The addition of these four codes is very valuable, says Quintana. They describe a different diagnostic procedure. Being able to report them accurately in this manner is beneficial.

Shanser points out that, with each of the codes listed above, code 72275 may be reported for the image associated with each injection.

Specific Guidance Code

Another new significant radiologic code is 76005, Shanser reports, which allows the physician to bill for fluoroscopy associated with diagnostic or therapeutic injection procedures. In the past, radiologists assigned the more general code, 76000 (fluoroscopy [separate procedure], up to one hour physician time, other than 71023 or 71034 [e.g., cardiac fluoroscopy]).

CPT 76005 represents an important change, he says, since it directly reflects the fluoroscopic imaging services provided during spinal injections.

However, 76005 offers a potential hazard for coders, he warns. When these codes were initially announced in November 1999, some coders interpreted 76005 as an add-on code, to be assigned in conjunction with 72275. This is not the intent, however. When assigning 72275 for epidurography, you should not also report 76005 for guidance76005 is considered to include the fluoroscopic imaging.

Also, 76005 cannot be assigned to describe fluoroscopic guidance for subarachnoid punctures for diagnostic radiographic myelography. This service is included in the associated supervision and interpretation codes 72240 (myelography, cervical, radiological supervision and interpretation), 72255 (myelography, thoracic, radiological supervision and interpretation), 72265 (myelography, lumbosacral, radiological supervision and interpretation) and 72270 (myelography, entire spinal canal, radiological supervision and interpretation).

The CPT definition of 76005 also notes that the injection of contrast during fluoroscopic guidance and localization is an inclusive component of surgical codes 62270-62273, 62280-62282, 62310-62319.

Two New Codes for Injection of Sacroiliac Joint

The third significant new radiologic code is 73542, which cross references to the new procedure code 27096 (injection procedure for sacroiliac joint, arthrography and/or anesthetic/steroid). These new codes allow radiologists to be reimbursed for the injection of contrast into the sacroiliac joint, and for the interpretation of the sacroiliac joint arthrogram, points out Quintana.

Although 73542 is the code most likely to accompany 27096, CPT guidelines indicate there are times when 76005 may be more appropriate. Code 73542 should be assigned only when formal arthrography is performed and recorded, and a dictated radiologic report is issued. In cases where fluoroscopy is used strictly for guidance and localization during sacroiliac joint injections, code 76005 should be reported.

New Facet Injection Codes

Shanser points out four additional new surgical codes that radiologists who perform spine injections may use. These four codes describe injections into the facet joints of the vertebral bodies. First, the needle is placed into a facet joint, then contrast is injected. Finally, images are taken to confirm the intra-articular location of the needle.

CPT 64470 is defined as injection, anesthetic agent and/or steroid, paravertebral facet joint or facet joint nerve; cervical or thoracic, single level. Code 64472 is an add-on code for cervical or thoracic, each additional level. Code 64475 should be assigned for lumbar or sacral, single level, and 64476 is an add-on code that describes lumbar or sacral, each additional level.

Epidurography code 72275 should not be assigned in addition to any of these four codes, Shanser notes, even though the descriptions are similar to the 64479-64484 series, to which the epidurography code may be added. Code 76005 is more appropriate in this situation.