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Pain Management & 72275

  1. #1
    Marville, Illinois
    Default Pain Management & 72275
    Medical Coding Books
    Looking for assistance with coding for 62310 - 62319 AND 72275. Per CPT, "use 72275 only when an epidurogram is performed, images documented, and a formal radiologic report is issued." Does this then mean if the physician performing the injection verifies the findings of the epidurogram that he must have the images and the formal report? OR is this only for the technical side, i.e. 72275-TC? Have been coding the 62xxx codes with a 26 modifier but now getting denials indicating 72275-26 needs a -59 modifier as well. Clarification on this issue would be appreciated! Thanks to all who respond. (p.s. new to coding for pain management).

  2. #2
    Alexandria, LA
    Is the doctor doing a diagnostic epidurogram or is he injecting under fluoro guidance? If this is a diagnostic exam where the physician is deciding what's wrong and what to do next, then 72275 would be coded with modifier 59. (and 26 if only billing for the professional component.
    If, instead, he is using fluoro for guidance, then code 77003 would be correct.
    Many doctors dictate "epidurogram" when all they are doing is guidance, so you have to be careful, and they need to be educated. (same thing for arthrogram and myelogram when it's really guidance for injection.)

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