Wiki coding confusion - Is it ok to code

[LaVoncye]

Is it ok to code the 72275 along with the 64483. Im confused as to the wording , I know it says the 72275 includes 77003. So I'm guessing the proper was to code a
1. Selecive Transforminal epidural steroid injection at L3,L4,L5 under fluoroscopy
2. Lumbar epidurogram

Would be :
64483 LT
64484 LT
64484 LT 76
72275 59 26 at the procedure was performed in the ASC

My confusion is because it states the epidurogram includes fluoroscopy and you cannot bill the Fluoroscopy as a separate procedure. Does this mean that you cannot bill the epidurogram separately as well?

 

[dwaldman]

For Medicare in an ASC, you would not be doing diagnostic procedures since the ASC coverage is for surgical procedures only.

I would review this face to face with the physician. Is an MRI or CT myelogram contraindicated and the patient has to have a epidurogram for further diagnosis of the patient or is for assistance in performing the block.

There has to be formal contrast study with a diagnostic intention to report 72275, if this is clearly not the indication for the epidurogram portion then it would not be separately reportable.

The fact that it is bundled and you would have to add the 59 modifier you would want to make sure you have exhausted all querying of the physician regarding the intention of the procedure, so there is not misuse of the 59 modifier.