Note: The following project was submitted by a non-member. Contact details are located below the project description if you are qualified and interested.

Project Description:
We are seeking an physician/certified coder.

First, a facility is routinely billing $200 per patient per day for transportation under either CPT Code 99082 or HCPCS Code S0215-SG. This amount is greater than the fee scheduled amount for emergency ambulance services. The transportation charges appear to be billed by a provider not licensed by the New Jersey Department of Health and Senior Services. Is CPT Code 99082 reserved for unusual travel that involves a physician escort? Do billings under the HCPCS Code S0215 allow for non-emergency transportation on a charge per mile basis? Once again, the Surgical Center is not licensed to provide medical transportation services and is uniformly billing $200, each day per patient, regardless of the mileage.

We need to examine if there were mutually exclusive edits or code pairs that were improperly billed for the same patient on the same day. We need to determine if the provider was likely aware that the billing is prohibited. Examples at issue here include CPT Code 77003 is for "fluoroscopic guidance and localization of needle or catheter tip for spine or paraspinous diagnostic or therapeutic injection procedures (epidural, transforaminal epidural, subarachnoid, paravertebral facet joint, paravertebral facet joint nerve, or sacroiliac joint), including neurolytic agent destruction" and the code book statement: "Injection of contrast during fluoroscopic guidance and localization [77003] is included in 22526, 22527, 62263, 62267, 62270-62282, 62310, 62319, 0027T". The facility is routinely billing for 62319 when it bills for 77003.

For at least one patient, the Surgical Center billed for CPT Codes 62311 (lumbar epidural injection) and CPT Code 72275 (epidurography) on the same day on three separate dates. Do the services described by CPT Code 62311 include an epidurogram? What is the effect of the CPT Code requirement that a formal radiologic report be issued when billing under 72275?

We are seeking an expert to provide a single comprehensive report discussing the billing of the Surgical Center for all files we have received to date (10). We need an opinion on whether the routine billing violations committed by the facility are intentional and constitute material misrepresentations of services rendered.

Contact Information:
Please call Michael Eatroff at 732-248-4200 x 152 or email