Wiki R L5 and S1 transforaminal flouroscopically guided epidural injection

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msingh23

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Patient undergo R L5 and S1 transforaminal flouroscopically guided epidural injection.
Provider Billing For The following:
Office consultation 99244-25
Lumbar injection single level CPT-64483
Lumbar injection each additional CPT-64484
Fluoroscopic spine injection CPT-77003-26
Celestone 6 mg/cc J-0702
Celestone 6 mg/cc J-0702
Bupivicaine CPT-J3490

I will like to know if a consult can be biil with this service.
Thanks
ms
 
I don't think you can bill 77003 with 64483, 64484. As for the consult if it is Medicare or anyone who follows NCCI edits then a consult code cannot be used. An office visit charge is possible if documentation supports the charge.
 
CPT 64483 does include the 77003 for guidance. Injection(s), anesthetic agent and/or steroid, transforaminal epidural, with imaging guidance (fluoroscopy or CT); lumbar or sacral, single level.
For consult billing, non-Medicare, you need the written referral request from the PCP, and you need to respond to them with a written report and document their request, AND have a significant E&M reason separate from the low back pain since it appears the consult and injections were done the same day; AND per ODG for epidural injections: (1) Radiculopathy (due to herniated nucleus pulposus, but not spinal stenosis) must be documented. Objective findings on examination need to be present. Radiculopathy must be corroborated by imaging studies and/or electrodiagnostic testing.
(2) Initially unresponsive to conservative treatment (exercises, physical methods, NSAIDs and muscle relaxants).
(3) Injections should be performed using fluoroscopy (live x-ray) and injection of contrast for guidance.
 
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