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72275 denied

  1. Default 72275 denied
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    Cpt codes 62311, 27096, & 72775 were billed together.

    62311 & 27096 was paid, but 72775 was denied.

    Should this be? & under what guidelines can 72775 be paid?

  2. #2
    " The use of code 72275 is for diagnostic purposes and is not indicated or appropriate to use for needle localization in the majority of therapeutic epidural steroid injections or similar procedures in lieu of code 77003."

    __________________________________________________ ________________________
    Above and below are from CPT Assistant 2008. I would review the intent of the injection of contrast to assist with performing the injection or for diagnostic purposes. Was a formal diagostic interpretation documented to support 72275?
    __________________________________________________ ______________________
    "The indications for the use of diagnostic epidurography are limited. The vignette associated with code 72275 for the AMA/Specialty Society Relative Value Scale Update Committee (RUC) describes the use of epidurography to determine whether there are obstructions in the epidural space that would limit the spread of therapeutic substances that may be injected, such as a neurolytic substance for chemical rhizotomy. The data obtained from the diagnostic epidurography should influence and improve patient treatment options and contribute new information to that already obtained from other spinal imaging procedures commonly used, such as magnetic resonance imaging and computed tomography with myelography. Epidurography should not be used routinely for localization with the performance of most therapeutic spinal injection procedures, as this is best addressed by code 77003."

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