Epidurogram

Started by painfree23
Get help with your application

Use all the free resources available to you from SDN: articles, guides, expert advising, forums discussions, and school research.

Browse articles Compare schools My application plan Read Interview Feedback
Practice for interviews Ask an Advisor
P

painfree23

Full Member
7+ Year Member
do you routinely bill for an epidurogram for ESI or transforaminal injections?

If you do an LESI, do u bill the epidurogram in addition to the 62323 (bc this includes the fluoro)
 
I probably could've billed for one today. Did an epidural for a hot L5 radic from a large L4-5 posterolateral protrusion. The contrast outlined the protrusion nicely on my contralateral oblique view.
 
This is what I've found when it comes to epidurograms. I think it's an overbilling/fraud issue. Similar to unbundling flouro guidance from epidural injections.

Coding of Diagnostic and Therapeutic Spinal Procedures - American College of Radiology
Epidurography

"Epidurography consists of a diagnostic evaluation following an injection of contrast into the epidural space, and must include permanent image-recording and a formal diagnostic radiology report. The injection of contrast alone is not sufficient to code for a formal diagnostic study, since CPT defines spinal injection surgical codes as being inclusive of the injection of contrast. In epidurography, the epidural space is visualized to evaluate the nerves and nerve roots, and to identify whether there is free flow of contrast within the epidural space. Areas of scarring, swelling, narrowing, or abnormalities of the nerves can be seen. Based on the findings of epidurography, treatment options can be considered. When epidurography is performed as a separate diagnostic study, CPT code 72275 may be used. The injection procedure for epidurography is coded separately with 62311. Code 72275 includes the use of fluoroscopy. If epidural injections are performed in separate regions of the spine, each region may be coded and reported separately.4 For example, to report epidurography performed at the cervical and lumbar regions, codes 62310 and 72275 would be reported for the cervical region, and codes 62311 and 72275 would be reported for the lumbar region."
 
I was always under the assumption that epidurogqram was bundled into the ESI code. So, I've never billed it. I'd think that's even more certain now that there are "contrast" and "non-contrast" ESI codes.
 
Besides it being bordering on fraud, the code is never covered when submitted for PA's anyways. I'd imagine the only time it would ever be paid would be auto/worker's comp. I would not bother billing unless you like audits.
 
PapaDosh said:
Besides it being bordering on fraud, the code is never covered when submitted for PA's anyways. I'd imagine the only time it would ever be paid would be auto/worker's comp. I would not bother billing unless you like audits.
Click to expand...

i am not suggesting this, but ive seen hospital based docs bill it for the RVU. the administrators are clueless and the doc will get the value for the RVU without the actual $$# coming in. ive seen it work for years without a problem for this particular (a-hole) doc
 
SSdoc33 said:
i am not suggesting this, but ive seen hospital based docs bill it for the RVU. the administrators are clueless and the doc will get the value for the RVU without the actual $$# coming in. ive seen it work for years without a problem for this particular (a-hole) doc
Click to expand...

If CMS, then retroactively they can and should take back the money. This is fraud unless performed as a diagnostic only with no steroid, no therapeutic intent.
 
lobelsteve said:
If CMS, then retroactively they can and should take back the money. This is fraud unless performed as a diagnostic only with no steroid, no therapeutic intent.
Click to expand...

A. it would piss off a lot of people
B. If not sure the hospital actually got paid for the service, so i dont think they can retroactively take money back that was never paid.
C. i dont think medicare would go after the small potatoes, especially if they never paid it out. i cant track the collections
D. the people upstairs know my thoughts on the subject
 
SSdoc33 said:
A. it would piss off a lot of people
B. If not sure the hospital actually got paid for the service, so i dont think they can retroactively take money back that was never paid.
C. i dont think medicare would go after the small potatoes, especially if they never paid it out. i cant track the collections
D. the people upstairs know my thoughts on the subject
Click to expand...

The hospital can take back the money credited to the doc. I have reviewed cases of this on other doctors before and assisted with garnishing and then firing of the offending doc.
RVU's do not just double in a year.
 
You must log in or register to reply here.