February 2000 Bulletin

Pain management CPT codes revised

Telecommunications industry racing to bring broadband technology to office, home

By Joanne L. Mehmert

Medical technology continually surpasses CPT codes, the lifeblood of billing for every specialty. Billing personnel will attest to the fact that when there is no CPT code there may be inadequate reimbursement by insurance carriers, or no carrier reimbursement. Pain management is an area that has been overdue for code revision. The CPT editorial staff greets Y2K with new and revised CPT codes for spinal injection and nerve block procedures. Physicians who treat patients that suffer acute and chronic pain can look forward to CPT code descriptions for spinal injection and nerve block procedures that more accurately describe current treatment modalities.

There are new codes to describe cervical and thoracic facet injections and denervation procedures. Additionally, there are codes for placement of catheter for continuous infusion or subsequent bolus injection in the cervical and thoracic spine, lysis of epidural adhesions, sacroiliac joint injection, fluoroscopic guidance and SI arthrography and epidurogram studies.

CPT 2000 codes, 62310 injection, single (cervical) and 62311, injection, single (lumbar) replace CPT codes 62274, 62275, 62278, 62288, 62289 and 62298. CPT code 62318 placement for continuous infusion or intermittent bolus, cervical or thoracic is new, however CPT code 62319, placement for continuous, lumbar or sacral replaces 62279.

Spinal injection codes are inclusive of all usual substances injected during a procedure, (contrast, anesthetic, antispasmodic, opioid, steroid, other solution), with the exception of neurolytics (alcohol, phenol, iced saline). Injection of contrast is included, however, neither fluoroscopic localization nor an epidurogram report is included; both can be billed separately, but not together.

There is now a separate code to report SI Joint injections, previously reported as a "large" joint injection, 20610. CPT code 27096 includes injection for arthrography and/or anesthetic/steroid. If formal arthrography is performed with a diagnostic report, code 73542 is submitted.

There may be some confusion on the part of coders as to correct application of CPT codes 76005, 72275 and 73542. CPT codes 72275 and 73542 must be supported by documentation of a ‘formal radiological report’ in the patient’s medical record.

If there is no diagnostic report and fluoroscopy was utilized for localization and needle position, report CPT code 76005; with modifier -26 when the physician is performing service in an ambulatory surgical center or outpatient hospital setting. If the physician owns the equipment and performs the procedure in an office or clinic, no modifier is required.

Medicare reimbursement for office based procedures has increased significantly while physicians who perform procedures in an outpatient or ambulatory facility will experience a decrease, according to RBRVS information published in the Nov. 2, 1999, Federal Register. Examples do not include geographic wage index adjustments:

OP/ASC

20610

1999

RVU

1.13

=

39.25

27096

2000

RVU

1.55

=

56.75

62289

1999

RVU

3.06

=

106.28

62311

2000

RVU

2.12

=

77.64

Office

20610

1999

RVU

1.60

=

55.57

27096

2000

RVU

11.55

=

408.24

62289

1999

RVU

3.45

=

119.82

62311

2000

RVU

5.45

=

199.54

 

It will take patience and perseverance to educate insurance carriers. Contact your third party payers and ask them when you can begin to use new codes to save yourself a lot of claim denials for ‘invalid code.’

Joanne L. Mehmert, CPC, is a principal at Auditing for Compliance and Education Inc., Kansas City, Mo.

Question:

When would code 76000 be appropriate to bill? I know that code 76000 is not to be used when it is part of another procedure. However, when it is done alone to review for abnormalities, etc., then I am assuming that it can be billed. Would the orthopaedist also have to dictate a separate report indicating that fluoroscopy was used and for how long?

Kim Hatchie, ART, CPC

Group Health Cooperative

Seattle, Washington.

Answer:

Code 76000 can be billed only if no other procedures are being done. If the physician is using the fluoroscopic imaging for further determination of previous films, it is questionable that it would be a billable service in that it may be determined that it is part of the decision-making process. If the physician does meet the requirements to bill for 76000, then he also would have to follow the guidelines for billing professional components. The report needs to state more than it was just used and how long; it must state why it was done, what the findings were and how long.

Margie Scalley Vaught

Answers to common coding questions may be addressed in future editions of the Bulletin. Fax (847) 823-8026.


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