Orthopedic Coding Alert

Report Just 1 Unit Per Day

Wrong way: Despite the fact that CPT assigns 62263 to a procedure of two or more days and 62264 to a one-day procedure, some coders still try to report additional units each time physicians perform additional injections.

"One of our surgeons sometimes writes '62263 x 3 injections' on the chart," says Debbie Oldfield, biller at Spine Associates LLC, a four-physician practice in Jackson, Miss. "I know not to put more than one unit of 62263 on the claim, but it would be easy for a new coder to try to bill three units, which is wrong."

Right way: "Code 62263 is NOT reported for each adhesiolysis treatment, but should be reported ONCE to describe the entire series of injections/infusions spanning two or more treatment days," according to CPT.

And don't even try to submit one unit of 62263 with one unit of 62264 to reflect three days' worth of lysis. The National Correct Coding Initiative (NCCI) considers 62264 a component of 62263, so Medicare and most other carriers will immediately deny 62264 if you report these codes together.

Don't Report Fluoroscopy Separately

Remember: You should never separately report fluoroscopy or epidurography when you bill 62263 or 62264. "These two codes specifically state that you cannot bill separately for fluoroscopy," says Annette Grady, CPC, CPC-H, senior healthcare consultant at Eide Bailly LLP in Bismarck, N.D., and chair of the North American Spine Society's administrative task force.

A parenthetical in CPT states that 62263 and 62264 include the services represented by 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) and 72275 (Epidurography, radiological supervision and interpretation).

Check Local Insurers' Guidelines

Although many insurers cover the Racz procedure, some payers still consider it investigational. Blue Cross and Blue Shield of North Carolina's (BCBSNC) policy states, "BCBSNC does not provide coverage for Racz neurolysis. It is considered investigational. BCBSNC does not provide coverage for investigational procedures."

If your insurer does not cover the Racz procedures, you should periodically contact the payer to determine when it intends to reconsider its policy. BCBSNC's guidelines, for instance, state that the payer intends to review its Racz policy again in August 2004.

Don't miss: Carriers that cover Racz procedures often maintain strict guidelines. Palmetto Medicare's (a Part B carrier in South Carolina) policy states, "Lysis of adhesions to relieve pain attributed to chronic
arachnoiditis may be covered when an epidurogram shows scarring at a spinal level consistent with the pain pattern of the patient."

If your carrier requires epidurographic evidence, always keep a copy of the epidurography results with the patient's chart (not just on the computer or with the radiology department). This way, if your insurer ever requests the documentation, you will have it at your fingertips.