Wiki Epidurography w/epidural injection

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dchenkin

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Under what scenario would it be proper to bill code 72275 (epidurography) during the same session as 62311, the actual epidural injection?

According to the Col1/Col2 edits it is only allowed with the proper modifier, in my case -59, but there still has to be a foundational basis to justify 72275 as a distinct procedure.
 
When I wrote NCCI asking is it possible to bill 62311 72275 together and in what circumstance, they could not provide a scenario that they suggested modifier 59 would be appropriate.

It left me to take the personal stance that it is content of service and not separately reportable with 62311.
 
Very interesting. However, while I appreciate your position, as I tend to agree with you, my problem is a little more complicate. I work for a law firm and part of duties is to analyze provider bills for compliance to the New York State Workers Compensation Fee Schedule. I need something more official than my own view to convince a judge or an arbitrator that it was improper for the provider to bill both codes.

Your response actually begs another question. Did NCCI provide any information as to which modifier would be appropriate to bill the two codes together? (Also I never thought to contact the NCCI people directly. Thanks for that tip.)
 
Below is from AMA CPT Changes 2000, which is good description of what the procedure entails. 76005 has been updated to 77003

Rationale

As part of the comprehensive revisions to the spinal injection section of CPT 2000, new code 72275 was added to describe the work involved in the radiologic supervision and interpretation services associated with epidurography. Epidurography includes a diagnostic imaging evaluation following an injection of contrast material into the epidural space under direct fluoroscopic visualization. This allows for evaluation of the epidural space around the target nerve roots or spinal nerves. Visualization of the free flow (or lack thereof) of contrast material in the epidural space assists in identifying focal scarring, areas of moderate to severe narrowing in the diameter of the nerve/nerve root, moderate to severe swelling of other parts of the nerve/nerve root, and the shape and size of the target nerves. Based on the epidurographic findings, potential treatment options can be evaluated.

Code 72275 differs from code 76005 in that it represents a formal recorded and reported contrast study that includes fluoroscopy. Code 72275 includes the use of fluoroscopy. Therefore, it is not appropriate to report code 76005 in addition to code 72275. Other examples of formal contrast studies are myelography and/or arthrography.
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Below you can write NCCI and see if they can have clarification of this edit, I didn't receive any specification information that I could see the justification of use of modifier 59.

http://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/index.html


National Correct Coding Initiative
Correct Coding Solutions LLC
P.O. Box 907
Carmel, IN 46082-0907

Attention: Niles R. Rosen, M.D., Medical Director and Linda S. Dietz, RHIA, CCS, CCS-P, Coding Specialist

Fax #: 317-571-1745
 
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