Anesthesia Coding Alert

Hint:  Maybe or maybe not, depending on the information providers give

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 Close Attention to Arthroscopy and Epidurography Pain management or anesthesia practitioners see this situation most often with arthrography and epidurography procedures, says Eileen Lorenco, RHIT, CS, CPC, a coder with Lahey Clinic in Burlington, Mass. -Our pain management physicians will sometimes perform an epidurogram just before an epidural injection, or an arthrogram just before an SI [sacroiliac] joint injection,- she says.

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 higher-base-unit--codes for the procedures; if it doesn-t, you-re relegated to more general--and 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 extra documentation is necessary. This important bit of information actually comes after the code definitions in the parenthetical notes.

Arthroscopy 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.-

Certification check: A physician must be credentialed and privileged by the radiology department before completing a formal radiologic report in a hospital or surgical center. Verify that your physician has these privileges before billing for a formal radiologic report.
 
Translate It to Your Bottom Line  Reporting 76005 for these procedures instead of 73542 or 72275 nudges your bottom line down, whether you look at base units or dollar amounts, say Lorenco and Cindy Clark, anesthesia coding supervisor with Anesthesiology Consultants in Savannah, Ga.

Base-unit breakdown: Codes 72275 and 73542 are each three base units, but 76005 is only two base units. For a physician charging a commercial carrier $50 per unit, he automatically loses $50 for the [...]