27093 and 73525

CoderinJax

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I'm in need of some assistance to verify that an Op Report was documented correctly for CPT codes 27093 and 73525. Below is how the report reads:

"PROCEDURE NOTE- AP and lateral views of the left hip were performed to identify the left hip joint. There is no evidence of fracture or dislocation. Using a 22-gauge 5" needle, the needle was placed into the LT hip joint using the lateral approach with frequent AP and lateral imaging to ensure accurate placement.
1 ml of Isovue-M 300 was injected slowly under fluoro and once the needle entered the superior aspect of the joint, aspiration was negative for blood/fluid.

ARTHROGRAM- Following the administration of contrast, the joint was visualized. No evidence of fracture or dislocation or abnormality. I injected Ancef 1 gram and remaining volume of .25% preservative free lidocaine was injected into the LT hip."

Does this support both 27093 and 73525? Should there be stored images as well?
Thanks!
 

CoderinJax

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If you're looking to bill for the anesthesiologist, you would use 27095 and crosswalk it to the ASA code 01200.
Thanks for the response! This is for a pain management MD, so it should be 27095 and not the other 2 codes? There was no anesthesia, so that code doesn't look right to me. I am trying to see if the note above supports the 2 CPT codes they're billing.
 
Last edited:

Davieda Skobel

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The Dr.s dictation supports the codes very well and yes there needs to be documentation of the needle placement in the chart. I was taught years go with radiology that if you are going to charge for it you need documentation that it was done and done correctly. Better safe than sorry.This wisdom was learned after many denials and appeals!!!!

This is just my opinion and I don't know the insurance that you are billing but this will definately satisfy Medicare.
Good Luck!
Davieda Skobel CLPN, CPC
Columbus, Ohio
 

dwaldman

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Here are some additional references I could find for your question.


AMA CPT Section Guidelines
Supervision and Interpretation (Radiology)
Imaging may be required during the performance of certain procedures or certain imaging procedures may require surgical procedures to access the imaged area. Many services include image guidance, and imaging guidance is not separately reportable when it is included in the base service. CPT typically defines in descriptors and/or guidelines when imaging guidance is included. When imaging is not included in a surgical procedure or procedure from the Medicine section, image guidance codes or codes labeled "radiological supervision and interpretation" (RS&I) may be reported for the portion of the service that requires imaging. All imaging guidance codes require: (1) image documentation in the patient record and (2) description of imaging guidance in the procedure report. All RS&I codes require: (1) image documentation in the patient's permanent record and (2) a procedure report or separate imaging report that includes written documentation of interpretive findings of information contained in the images and radiologic supervision of the service.



AMA CPT Assistant June 2012
Coding Clarification: Hip Arthrography

".......Hip injection of an anesthetic or steroid under fluoroscopic guidance should not be confused with hip arthrography. When a conventional (radiographic) hip arthrogram is performed,
it is reported with an arthrography injection code (code 27093, Injection procedure for hip arthrography; without anesthesia, or code 27095, Injection procedure for hip arthrography;
with anesthesia), and the arthrography imaging code 73525, Radiologic examination, hip, arthrography, radiological supervision and interpretation. In this instance, code 77002
is not reported in addition to code 73525 because current imaging practice dictates that fluoroscopy [77002] is considered a component of organ/anatomic-specific radiological
supervision and interpretation procedures (ie, 73525). The key is not the actual volume of contrast injected, but the intention. If the contrast is injected only to confirm
needle position within the joint, the quantity does not matter. If instead the contrast is injected with the intention to outline the joint surface to perform a radiographic
arthrogram, then it is an arthrogram even if only a few cc’s of contrast material are injected. Again, it is not the volume of contrast but the intention that defines
the service."
 
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