Analysis of CPT 2000 Changes:
New/Revised Spinal injection Codes Add Backbone to Radiology Reimbursement
Published on Wed Mar 01, 2000
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 [...]
