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Still not clear on interlaminars and 77003

Discussion in 'Pain Medicine' started by knoxdoc, Jan 22, 2012.

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  1. knoxdoc

    knoxdoc New Member

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    My billing chick is driving me nuts about this. She insists I will not get paid for 77003 with 62310 and 62311. I checked the 2012 CPT manual on page 292 and the wording does seem to exclude interlaminars now. Does anyone know yet?
  2. bedrock

    bedrock Member

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    Your billing person is plain wrong. She works for u and not the other way around. Tell her to bill the the 77003 with interlaminars, end of story. Ultimately the physician is responsible for what is billed, so if you want something billed, it gets billed.

    Print out the summary of coding changes on the ISIS homepage if you want to her to see it in black and white.
  3. facets

    facets

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    u can try asipp webite also they are a great resourse
  4. knoxdoc

    knoxdoc New Member

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    Thanks for the info! The ISIS page does spell it out perfectly - I just hadn't been there in a while. That's exactly what I needed.
  5. facets

    facets

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    Glad to help.
  6. PMR 4 MSK

    PMR 4 MSK Large Member SDN Advisor

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    Fuoro is not bundled with ILESI. Contrast and other injectables are.

    Fluoro is bundled with TFESI, MBB, FJI and RFA
  7. knoxdoc

    knoxdoc New Member

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    and sacroiliac joints now too, if I understand the new codes correctly...
  8. bedrock

    bedrock Member

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    yes,

    unfortunately
  9. bedrock

    bedrock Member

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    I though you could still bill your steroid with an ILESI. I haven't been able to get a clear answer on that one.
  10. PMR 4 MSK

    PMR 4 MSK Large Member SDN Advisor

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    Yes, re-reading it, I believe you are correct. Contrast is included/bundled, not steroid.
  11. cowensx2

    cowensx2

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    They did not bundle 62310 and 62311, because if they did bundle it they wouldhave to increase its RVU value to accommodate the bundling.

    62310 and 62311 are performed all the time without flouro i.e. preoperativeOR anesthesia and OB anesthesia.

    If they bundled it and increased its RVU then the preoperative OR anesthesiaand OB anesthesia 62310 and 62311 would have an increased RVU value and getpaid more i.e. costing them a lot of money.

    So they did not bundle it like they did everything else so they could save themselvessome money not to help us.
  12. knoxdoc

    knoxdoc New Member

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    I like that explanation. Thanks.
  13. Jcm800

    Jcm800

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    62311 is not the same code as for OB or peri-operative anesthesia...

    CPT codes 62310 (cervical or thoracic) and 62311 (lumbar) describe a single injection of a diagnostic or therapeutic substance, not including neurolytic substances, directly into the subarachnoid or epidural space. This type of spinal injection is often described as an interlaminar epidural injection, because of the injection technique being performed directly through the lamina, positioning the needle close to the midline in the back of the epidural space.

    but yes, it is NOT bundled...
  14. Ducttape

    Ducttape Lifetime Donor

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    bringing up old thread... shame on me...

    but it is now end of july, 2013, and i got denial from medicare, first one, for 77003 and 62310, because it is now bundled.

    sigh...
  15. lobelsteve

    lobelsteve www.stevenlobel.com Lifetime Donor

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    Not according to my LMRP.
  16. clubdeac

    clubdeac

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    That's bull****! It shouldn't be bundled, not in 2013. Since when can they change the ****ing rules mid year? I'm getting so sick of this ****!. We need to strike, seriously. Insteading of sighing and saying, oh bummer, we need to ban together and do something about this bs........

    I'm in a pissy mood if you couldn't tell
  17. emd123

    emd123

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    I don't think it's bundled. Next year it will probably be bundled. Do you have any documentation from them that it's bundled now? Sometimes they just start denying stuff to see if you'll catch it or not, and if not they keep the cash. Appeal it.
  18. Ducttape

    Ducttape Lifetime Donor

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    Notice sent to patient from Medicare denying payment for fluoro. I asked patient to bring it in, but patient specifically stated it was for $110 and "number 77003".... Pretty unequivocal from a patient.

    Told my coder. She looked in the 2013 code book and tells me it is bundled... Was news to her too...
  19. lonelobo

    lonelobo New Member

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    CMS has not not bundled it for 2013
  20. emd123

    emd123

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    Copy and post please.
  21. mille125

    mille125

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    It will never be bundled because anesthesiologist do it everyday for surgical patients without fluoro.
  22. Ducttape

    Ducttape Lifetime Donor

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    right now, labor epidurals have their own code, 01967.

    read how confusing it is right now (from codeitrightonline.com)

    i can imagine them rewording it so that 62310-62319 cannot be billed for postsurgical pain. some simple possibilities: 1. all epidurals for surgical pain get a new code and bundle fluoro into 62310-9; 2. all operative epidurals fall under 01967; 3. 62310-62319 get fluoro bundled, unless there is a modifier for postsurgical pain that negates the need for fluoro; 4. modify 62310-9 to say that any injection where steroids are used must be done under fluoro....
  23. specepic

    specepic

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    ILESI not bundled
  24. specepic

    specepic

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    i would bet someone is confusing interlam with tfesi, get all the facts in writing first (what codes are on all documents from and to your office) before sounding the alarm bells. "pt said...." "biller/coder said..." always schetchy
    Last edited: Jul 30, 2013
  25. bedrock

    bedrock Member

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    I guess they could do all that. I doubt they will do # 4 (all steroid injections must be done under fluoro), that's a bit broad.

    I still think ILESI will remain unbundled for quite a while just because not everyone does ILESI with fluoro and CMS loves the $95 they save from those docs.

    I could see them bundling sympathetic blocks before they try to bundle ILESI, because you must have fluoro to do sympathetic blocks. It's the only other common fluoro pain procedure that hasn't been bundled yet.
    Last edited: Aug 1, 2013

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