I'm getting ready to defend myself to a physician regarding a difference in opinion on coding these procedures. Any suggestions?
Procedures Performed: Left L4-L5 arthrogram
Left L4-L5 transforaminal epidurogram, and caudal
epidural
The patient was placed in a prone position and prepped and draped in the usual manner. A 25 guage Tuoy needle was inserted into the left L$-L% transoraminal space. A 1 ml onmipaque 300 injected. Arthrogram was performed. Once needle placement was confirmed, 1 ml lidocaine 1% ml celestone injected. Under fluoroscopy, a 22 guage tuoy needle was inserted into the caudal space. A 2 ml omnipaque 300 injected. Epidurogram was performed. Once needle placement was confirmed, 5 ml lidocaine 1% and 5 ml celestone injected.
Physician coded
62311 x 1 (caudal space) (bundled into 64483)
64483 mdf LT/59 (L4/L5 transforaminal space)
77003 (L4/L5) (bundled/inclusive into 77225)
77225 mdf/59 (bundled 62311/64483)
Medicare payor
An epidural block, bilateral sacroiliac joint injection, or lumbar sympathetic block should not be performed at the same spinal level on the same day as transforaminal epidural injection. Furthermore, only one type of a block or injection should be performed in a given session so that effectiveness of its treatment can be assessed prior to attempting another type of a spinal block or injection.
Procedures Performed: Left L4-L5 arthrogram
Left L4-L5 transforaminal epidurogram, and caudal
epidural
The patient was placed in a prone position and prepped and draped in the usual manner. A 25 guage Tuoy needle was inserted into the left L$-L% transoraminal space. A 1 ml onmipaque 300 injected. Arthrogram was performed. Once needle placement was confirmed, 1 ml lidocaine 1% ml celestone injected. Under fluoroscopy, a 22 guage tuoy needle was inserted into the caudal space. A 2 ml omnipaque 300 injected. Epidurogram was performed. Once needle placement was confirmed, 5 ml lidocaine 1% and 5 ml celestone injected.
Physician coded
62311 x 1 (caudal space) (bundled into 64483)
64483 mdf LT/59 (L4/L5 transforaminal space)
77003 (L4/L5) (bundled/inclusive into 77225)
77225 mdf/59 (bundled 62311/64483)
Medicare payor
An epidural block, bilateral sacroiliac joint injection, or lumbar sympathetic block should not be performed at the same spinal level on the same day as transforaminal epidural injection. Furthermore, only one type of a block or injection should be performed in a given session so that effectiveness of its treatment can be assessed prior to attempting another type of a spinal block or injection.