Neurology & Pain Management Coding Alert

Question: A patient came to the office for treatment of L3 radiculitis and ankylosis. The pain management specialist administered a transforaminal epidural steroid injection and an SI joint injection during the same session because the patient is on long-term anticoagulantsa and would be at risk for DVT if the anticoagulants had to be repeatedly stopped and restarted. He used epidurography to confirm epidural spreading and fluoroscopic guidance to assist with the joint injection. The payer denied our claim without explanation. How should we code the encounter? New Jersey Subscriber Answer: You need to evaluate whether any procedures your specialist performed are components of other procedures, especially when reporting several codes for a single encounter. First, consider the applicable codes: 64483 -- Injection(s), anesthetic agent and/or steroid, transforaminal epidural, with imaging guidance (fluoroscopy or CT); lumbar or sacral, single level 27096 -- Injection procedure for sacroiliac joint, arthrography and/or anesthetic/steroid 77003 -- Fluoroscopic guidance [...]