Still not clear on interlaminars and 77003

[knoxdoc]

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?

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[bedrock]

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.

 

[facets]

u can try asipp webite also they are a great resourse

 

[knoxdoc]

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.

 

[facets]

Glad to help.

 

[PMR 4 MSK]

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

Fluoro is bundled with TFESI, MBB, FJI and RFA

 

[knoxdoc]

Fluoro is bundled with TFESI, MBB, FJI and RFA

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

 

[bedrock]

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

yes,

unfortunately

 

[bedrock]

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

Fluoro is bundled with TFESI, MBB, FJI and RFA

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

 

[PMR 4 MSK]

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

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

 

[cowensx2]

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.

 

[knoxdoc]

I like that explanation. Thanks.

 

[Jcm800]

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...

 

[Ducttape]

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...

 

[lobelsteve]

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...

Not according to my LMRP.

 

[clubdeac]

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...

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

 

[emd123]

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...

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.

 

[Ducttape]

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...

 

[lonelobo]

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...

CMS has not not bundled it for 2013

 

[emd123]

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...

Copy and post please.

 

[mille125]

Copy and post please.

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

 

[Ducttape]

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

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

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

The National Correct Coding Initiative (NCCI) manual clarifies that an epidural or peripheral nerve block injection for postoperative pain management may be administered preoperatively, intraoperatively, or postoperatively and separately reported “when the epidural or nerve block is not used for intra-operative pain management”. CPT codes 62310-62311 and 62318-62319 (Epidural or subarachnoid (spinal) injection anesthesia- bolus, intermittent bolus, or continuous infusion) may be reported on the date of surgery if performed for postoperative pain management rather than as the regional block for the surgical procedure. But, if a narcotic or other analgesic is injected postoperatively through the same catheter as the anesthetic agent, then CPT codes 62310-62319 should not be reported for postoperative pain management.

According to the NCCI edits for 2013, certain post-operative pain management procedures may only be separately reported with general anesthesia. Specifically, the NCCI edits state that an epidural injection (CPT code 62310-62319) for postoperative pain management may be reported separately with an anesthesia code only if the intraoperative anesthesia is general anesthesia and the adequacy of the intraoperative anesthesia is not dependent on the epidural injection. The same applies to a peripheral nerve block injection (CPT codes 64400‑64530) for postoperative pain management. These may be reported separately if the intraoperative anesthesia is general anesthesia, subarachnoid injection, or epidural injection, and the adequacy of the intraoperative anesthesia is not dependent on the peripheral nerve block injection. Epidural and peripheral nerve block injections are not separately reportable for postoperative pain management if the mode of anesthesia for the procedure is monitored anesthesia care (MAC), moderate conscious sedation, or regional anesthesia by peripheral nerve block. In addition, if an epidural or subarachnoid injection is used for intraoperative anesthesia and postoperative pain management, CPT code 01996 (daily hospital management of epidural or subarachnoid continuous drug administration) is not separately reportable on the day of insertion of the epidural or subarachnoid catheter.

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....

 

[specepic]

ILESI not bundled

 

[specepic]

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...

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

 

[bedrock]

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

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....

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.