Wiki What can Radiologist bill for Epidural done by another doctor in radiology office?

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jbaird

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Can anyone tell me what to bill for the radiologist when an outside physician uses the radiologists office to do an epidural injection? The radiologist is dictating a report documenting the fluoro used & needle placement.

This is the documentation from 2 different reports:

EPIDURAL
CLINICAL HISTORY: bilateral back pain radiating into the legs
COMPARISON: None available
TECHNIQUE: Nine fluoroscopic images with fluoro time of 1.6 minutes
FINDINGS: Postoperative changes from anterior interbody fusion at L5-S1 noted. Needles positioned at the L4-L5 and S1-S2 levels four epidural steroid injection. See procedure note for details.
IMPRESSION: As above

EPIDURAL
Clinical Indication: Low back pain, pain is rating down the bilateral legs, left worse than right
Technique: Fluoroscopic images acquired during fluoroscopic guided epidural injections by Dr. XXXX utilizing 1.5 minutes of fluoroscopy.
Findings: There are bilateral epidural needles, and contrast present along the course of the bilateral L2 and L3 nerve root. Posterior spinal fusion hardware partially visualized.
Impression: Please refer to the procedure report for full procedural details.

Can I bill a 77003 or a one view spine?

Thank you!!
 
Epidural billing

I am considering billing 77003-52, since another doctor performed the exam. Can anyone tell me if they would agree with this?
 
I'm not sure there's anything for the radiologist to bill. Is he reading the images AFTER the injection procedure is already over?
 
Epidural billing

This is being done by a pain management doctor coming in to use the radiologist's office. It is the radiologist's office equipment and staff running the fluoroscopy and the radiologist is dictating a report to document the images & needle placement. I would have to go back and confirm for sure whether the radiologist is in the room, or if he is only dictating a report after the fact. I was concerned if I billed the fluoro code he would not be paid at all because it would be bundled into the code the pain management doctor would bill. I was adding the 52 to indicate he was not the physician performing the exam.

I think there should be some reimbursement for the radiologist & office. I'm not sure the best way to code/bill this that will accurately reflect what was done. Thanks for your time & help!
 
IMO, IF the physician performing the injection is using the fluoro code appropriately, and billing 77003-26, then there's no reason for the radiologist to need to do an interp report--there's no medical necessity for it. Your rad's office, since his equipment is being used, should bill the 77003-TC. I don't have experience billing the TC component of this code, so hopefully someone will chime in if I'm wrong.
 
Epidural billing

Do you think the 77003-TC would be denied as bundled? Is the 77003 included/bundled in the injection code?
 
jbaird said:
Do you think the 77003-TC would be denied as bundled? Is the 77003 included/bundled in the injection code?
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Per AMA/CPT guidelines, 77003 is not included in epidural injections such as 62310/62311--see the notes in the section header for "Spine and Spinal Cord Injection, Drainage, or Aspiration". However, Medicare, and several other payers, are now bundling the fluoro guidance with the injection, as of the beginning of last year, I believe. They did increase reimbursement of the injection code a little to help make up the difference. I'm not sure if the 77003-TC would also be bundled, in your case.
 
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