As seen below the following codes would be bundled into 64483 and it would not be appropriate to place the modifier 59 since they are integral to the performance of the procedure and performed during the same encounter. If an epidurogram is performed it would require a formal contrast study to be documented and the purpose of this was for diagnostic and assist with further diagnosis of the patient. With other imaging techniques available such as MRI or myelogram, you would want to be fully sure the intent was diagnostic and documentation supports that. The additional information below regarding why these codes are bundled is from the CMS National Correct Coding Inititiave policy manual. I would review these statements with the physician so he is more familiar with NCCI and what is considered incidental per Medicare standards.
Code 72275 is a component of Column 1 code 64483 but a modifier is allowed in order to differentiate between the services provided.
Code 96365 is a component of Column 1 code 64483 but a modifier is allowed in order to differentiate between the services provided.
Code 36000 is a component of Column 1 code 64483 but a modifier is allowed in order to differentiate between the services provided.
Code 36000 is a component of Column 1 code 96365 but a modifier is allowed in order to differentiate between the services provided
Code 94770 is a component of Column 1 code 64483 but a modifier is allowed in order to differentiate between the services provided.
Intravenous access (e.g., CPT codes 36000, 36400, 36410) is not separately reportable when performed with many types of procedures (e.g., surgical procedures, anesthesia procedures, radiological procedures requiring intravenous contrast, nuclear medicine procedures requiring intravenous radiopharmaceutical).
The global surgical package includes the administration of fluids and drugs during the operative procedure. CPT codes 96360-96376 should not be reported separately. Under OPPS, the administration of fluids and drugs during or for an operative procedure are included services and are not separately reportable (e.g., CPT codes 96360-96376).
2. Medicare Anesthesia Rules prevent separate payment for anesthesia services by the same physician performing a surgical or medical procedure. The physician performing a surgical or medical procedure should not report CPT codes 96360-96376 for the administration of anesthetic agents during the procedure. If it is medically reasonable and necessary that a separate provider (anesthesia practitioner) perform anesthesia services (e.g., monitored anesthesia care) for a surgical or medical procedure, a separate anesthesia service may be reported by the second provider.
3. Many procedures require cardiopulmonary monitoring either by the physician performing the procedure or an anesthesia practitioner. Since these services are integral to the procedure, they are not separately reportable. Examples of these services include cardiac monitoring, pulse oximetry, and ventilation management (e.g., 93000-93010, 93040-93042, 94760, 94761, 94770).
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