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CPT 62267 vs 20225

  1. #1
    Question CPT 62267 vs 20225
    Medical Coding Books
    Hello all. I do facility coding and have been presented with my first 'disc aspiration'. The CPT book states to not use 62267 in conjunction with 20225. I have included the report below. Does anyone have any additional documentation as to why the 2 should not be charged together? The IR Radiologist is surely going to jump down my throat if I tell him that both are no separately reportable. I would just like to have my facts in order before approaching the doc and techs. Thanks in advance for any info!


    HISTORY: 75-year-old [/B]diabetic male with chronic low back pain. Recent
    MRI raised concern for vertebral osteomyelitis and discitis at the
    L4-L5 levels. Patient is referred now for biopsy and aspiration.[/I]
    Intravenous conscious sedation was utilized for today's procedure with
    continuous nursing and physician monitoring for approximately one
    hour.

    After obtaining informed consent, patient's lower back was sterilely
    prepped and draped. Local anesthetic was applied and using direct
    biplane fluoroscopic guidance, an 18-gauge needle was advanced into
    the L4-L5 disc space. Aggressive manual aspiration was performed and
    material was removed and sent for multiple laboratory studies.

    A large-core biopsy of the L4 vertebral body was then obtained. A left
    posterolateral transpedicular approach was utilized to hammer an
    11-gauge core biopsy needle into the L4 vertebral body. Large-core
    biopsy was removed and also sent to laboratory for multiple studies.
    Hemostasis was obtained and patient left radiology in stable
    condition.

    IMPRESSION: Uncomplicated large-core biopsy of the L4 vertebral body
    and 18-gauge aspiration of material from the L4-L5 disc space
    performed with good technical results.[/B]

  2. #2
    Location
    Birmingham, Alabama
    Posts
    889
    Default
    Quote Originally Posted by cswift View Post
    Hello all. I do facility coding and have been presented with my first 'disc aspiration'. The CPT book states to not use 62267 in conjunction with 20225. I have included the report below. Does anyone have any additional documentation as to why the 2 should not be charged together? The IR Radiologist is surely going to jump down my throat if I tell him that both are no separately reportable. I would just like to have my facts in order before approaching the doc and techs. Thanks in advance for any info!


    HISTORY: 75-year-old [/B]diabetic male with chronic low back pain. Recent
    MRI raised concern for vertebral osteomyelitis and discitis at the
    L4-L5 levels. Patient is referred now for biopsy and aspiration.[/I]
    Intravenous conscious sedation was utilized for today's procedure with
    continuous nursing and physician monitoring for approximately one
    hour.

    After obtaining informed consent, patient's lower back was sterilely
    prepped and draped. Local anesthetic was applied and using direct
    biplane fluoroscopic guidance, an 18-gauge needle was advanced into
    the L4-L5 disc space. Aggressive manual aspiration was performed and
    material was removed and sent for multiple laboratory studies.

    A large-core biopsy of the L4 vertebral body was then obtained. A left
    posterolateral transpedicular approach was utilized to hammer an
    11-gauge core biopsy needle into the L4 vertebral body. Large-core
    biopsy was removed and also sent to laboratory for multiple studies.
    Hemostasis was obtained and patient left radiology in stable
    condition.

    IMPRESSION: Uncomplicated large-core biopsy of the L4 vertebral body
    and 18-gauge aspiration of material from the L4-L5 disc space
    performed with good technical results.[/B]

    This is a very interesting case, I would like to see some others answer as well.
    Here goes my answer..

    62267 "Percutaneous aspiration within the nucleas pulposus ...is a new code and per Correct Coding Initiative includes the biopsy code 20225 so they should not be billed together.

    However, when they are two separate procedures (as they are in this report IMO), the CCI allows for a modifier to be used.

    I would code as such:
    62267
    20225-59

    and I would be prepared to send documentation to support the codes to the payor. Good luck.

    HTH
    Danny L. Peoples
    CIRCC,CPC

  3. #3
    Default
    Thanks so much for your response! I did check the CCI edits after I submitted my initial question here and saw that the modifier would be permitted. I will make sure the documentation is gathered and ready for submission as I'm sure it will be requested. Again, thank you for the input and any others that might have some insight as well!

    Thanks much!
    Candy

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