Epidural 62311 72275-59 20553-59, 99144, 99145 J3301,

evillan2015

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I contantly have problems with United HealthCare regarding this procedure
62311
7775-59
20553-59
99144
99145
J3301
J2250

They always deny 72275-59 as bundled with main procedure 62311- We always submit the OP Report, with the Separate Radilogy Report
And sometimes they deny the 99144, 99145 which is the Sedation charges first 30 minutes, 2nd additional 15 minutes.
DX code: In this case in the order listed
M48.06
G54.0
M79.1

an someone help and shed some light as to what other way I should bill this procedure?

Each time I have to submit a Reconsideration Request with the Op & Radiology Report again even though they had it already, in addition I now send the AMA Policy guidelines for the Epidurogram (CPT 72275), and for the Sedation I pulled an article from CMS for 991445 & 99145- Called CMS Manual System Pub 100-04 Transmittal 1324- Subject Anesthisia Services Furnished by the Same Physician Providing the Medical and Surgical Service. and I highlight page three of the policy under 99143 to 99145.

Can someone help and shed some light as to what other way I should bill this procedure so I don't have to keep doing this?

Please advise , or feedback.

Thank you,

Elizabeth
 
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I'm a little confused, but I may be over-thinking it. Without any narrative or op note, it's difficult for me to understand why a diagnostic procedure is being done in conjunction with an epidural injection. Are these at different locations?
 

evillan2015

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Epidural

I'm a little confused, but I may be over-thinking it. Without any narrative or op note, it's difficult for me to understand why a diagnostic procedure is being done in conjunction with an epidural injection. Are these at different locations?

no. same location
 
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So you're billing 62311, which includes the placement of the needle or catheter, then you're billing 72275 which also includes the placement of the the needle. Are two separate needles being placed? If the needle is placed for the epidural (62311), why couldn't that needle access point be used to also inject the contrast material if this is all happening at one site? There is already some amount of contrast being injected with the epidural procedure, why is more needed? I think that might be what UHC is trying to relay in their denial.
 
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