Caudal Epidural Steroid Injections

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I have a new physician using new terminology I have not heard before. I received an op note for pain management stating:

"A skin wheel was raised using 1 ml of 1% Xylocaine."

The op report goes on to state the epidural procedure, no other injections or information. The provider wants to report 20552, 64483, 72275 and 77003 59. I read up on the skin wheel and it appears to be part of the anesthesia process and not separately reported. I am suggesting 64483, 72275 only. My question is: Is this appropriate?? Has anyone used this "wheel" term before? (None of my other providers use this)

Any thoughts?
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The skin wheel is just the area where the physician inserts the needle into. It is not billable.

Also, a caudal epidural injection is 62323 not a 64483 and not sure why you would be billing 20552. Epidurals also include fluoroscopy so you wouldn't bill the radiology codes.

Melissa Harris, CPC
The Albany and Saratoga Centers for Pain Managmeent


True Blue
Clovis, CA
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Just adding on to the good advice Melissa gave you.

The term is spelled incorrectly, which may be why you had a hard time. It's "weal" - an area of the skin which is temporarily raised, typically reddened, and usually accompanied by itching - most often used in describing hives.

In your case, they just did a topical numbing of the area where they intended to insert the spinal needle.

20552 - Trigger points - maybe at his old office, they incorrectly used this for topical numbing. It's definitely NOT for that.

72275 - Epidurogram - a diagnostic study. This probably was not even performed. Alot of doctors think any time they do something with fluoro, they get to bill this code. Doctors who do legal work also like to try to bill this code, and unbundle all of the components of an epidural.

If you are doing the procedure in your office suite that is not an ASC or other facility, AND the procedure does not include fluoro, you can bill the fluoro separately, but it's 7700x series, not 72275. In your case, the interlaminar epidural-lumbar/sacral/caudal with imaging (62323), already includes imaging, so it doesn't matter where it is done, you cannot bill fluoro.