Wiki Billing for Disscogram

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Talibah

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Greetings all: Our pain doc performs discograms frequently.
Example: Three level discogram I would bill to Medicare as
62290
62290-51
62290-51
72295-26
72295-26
72295-26

We are receiving payment for the three levels of 62290 and only one level of 72295. I was told that we should append modifier -59 to the additional 72295 codes. Is this correct? Also, Medicare has now started to ask for refunds for these procedures dating back to 2005, stating the provider was not eligible to bill for these particular procedures.

I am yet to speak with a representative to get clarification. There was some mention of specialty 49 which I understand to be an ASC. These procedure were performed in an ASC. Really confused. Any and all responses will be greatly appreciated.

Thank you,
Michelle
 
http://bulk.resource.org/gpo.gov/register/2005/2005_23701.pdf

Above is the reason ASC can not be reimbursed for a discogram.

Why not bill 72295 26 with quantity 3 instead of 26 59 on the two additional levels.

I have seen some Medlearn articles about how they will reimburse the physician if they perform a procedure in an ASC that is not on the ASC list but could not completely understand what they were saying. I did not try to fiqure it out since we make sure procedures that are not on the list are not perform in that particular setting.
 
As far as 72295 goes, according to anesthesiapainanswers.com many payers don't pay multiple levels for this code. Also, because the cpt code states interpretation and report, you need to have the diagnostic report available in the pt's record, otherwise you should bill 77003 instead.
 
I don't agree that they will not pay for separate levels. The discogram reports I see for each level it has an interpretation of what was seen on the fluoro describing each disc. I would not make sense that they would only pay for one level only because the work involved in reviewing each disc is significant and should be appealed if only one level is paid for.
 
Thanks to all for your replies. It seems as if we have found the issue. The line items were billed without a -26 modifier. (Hopefully that's there is to it).
The coder coded the report indicating that a -59 modifier should be attached to CPT code 72295. We are doing a second level appeal.

Thanks again,

Michelle
 
discogram

I work for a provider bill review company, we deny multiple levels of 72295 as the CPT definition does not include " each level " which is included in the CPT definition of discogram 62290 "injection procedure for discography, each level"
 
Donna McClary said:
I work for a provider bill review company, we deny multiple levels of 72295 as the CPT definition does not include " each level " which is included in the CPT definition of discogram 62290 "injection procedure for discography, each level"
Click to expand...

and those denials should be appealed since there is a CPT Assistant stating otherwise.

Also...

Discography

Discography, a diagnostic study performed by injection of contrast into an intervertebral disc, is reported with CPT codes 62290 and 72295 when performed in the lumbar region. Cervical or thoracic discography may be reported with 62291 and 72285. Both the surgical and RS&I codes should be reported once for each level injected and studied.

http://www.acr.org/Hidden/Economics...nosticandTherapeuticSpinalProceduresDoc6.aspx


AND-Medicaid (NC), of all people, even allow units...

Coverage of CPT procedure code 72295 (discography, lumbar, radiological supervision and interpretation) was increased to five units per day effective with date of service November 1, 2008
 
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