Radiology Coding Alert

Don't settle for a fluoroscopy code when 73542 or 72275 is more accurate Every day you have to determine whether your radiologist's documentation qualifies as a formal radiology report. If it does, you can report more detailed--and often higher-valued--codes for the procedures. If it doesn't, you're relegated to more general--and possibly lower-paying--codes.

Read on as in-the-trenches coders weigh in with their opinions on correctly reporting arthrographies and epidurographies.

"Our physicians will sometimes perform an epidurogram just before an epidural injection, or an arthrogram just before an SI [sacroiliac] joint injection," says Eileen Lorenco, RHIT, CS, CPC, a coder with Lahey Clinic in Burlington, Mass.

The coding options for these arthrography and epidurography procedures include:

• CPT 73542 (Radiological examination, sacroiliac joint arthrography, radiological supervision and interpretation) for the SI joint arthrography.

• CPT 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 you might not realize you need extra documentation. This important bit of information actually comes after the code definitions in the parenthetical notes.

Arthrography 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: A note following 72275 states, "Use 72275 only when an epidurogram is performed, images documented, and a formal radiologic report is issued."
 
Translate Documentation to Your Bottom Line
 
Reporting 76005 for these procedures if you've actually performed a procedure that warrants 73542 or 72275 nudges your bottom line down.

Dollar difference: The Medicare Fee Schedule includes a difference in average total nonfacility charges for fluoroscopy ($81.86) and arthrography ($114.07). And the jump to an average nonfacility charge of $126.20 for epidurography can be a good incentive for some providers to improve their documentation habits.

"The difference in amounts is not staggering but could add up over time," Lorenco says. "The real bottom line comes into play when you consider whether the physician is giving the correct documentation to support billing an epidurogram or arthrogram."

Example: If an auditor discovers that a physician lacks the documentation to support billing arthrography or epidurography, and that he repeatedly conducts the offense rather than making a one-time mistake, the physician could face steep financial penalties.

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