Coding Compliance: OIG Targets Transforaminal Epidural Injections

Posted on 17. Feb, 2010 by Editor.

Verify that you’re counting injections and levels correctly to keep claims clean.

The Office of Inspector General (OIG) Work Plan for 2010 includes a closer look at Medicare payments for transforaminal epidural injections. The Work Plan specifically states, “We will review Medicare claims to determine the appropriateness of Medicare Part B payments for transforaminal epidural injections.”

Stay out of the OIG crosshairs by ensuring that your pain management specialist documents each procedure thoroughly. Follow these steps to count levels and assign the appropriate codes correctly.

1. Understand What ‘Transforaminal’ Means

Physicians often administer transforaminal epidurals laterally through the selected neuroforamen under fluoroscopy, says Joanne Mehmert, CPC, CCS-P, president of Joanne Mehmert and Associates in Kansas City, Mo. Once there, the physician performs an injection at the nerve root area to help relieve the patient’s pain. The medication goes into the anterior epidural space, “bathing” a specific spinal nerve as it exits the spinal cord.

CPT includes four codes to represent transforaminal epidural injections, which you choose between based on the injection site and number of injections:

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How Do I Code an Epidural Blood Patch on Same Day as L&D

Posted on 03. Dec, 2009 by .

Don’t forget to double-check these 2 things to find the correct code.

Question: How do I code an epidural blood patch procedure on the same day as labor and delivery? Should I include a modifier?

Answer: Administering a blood patch on the same day as labor and delivery is unusual because most physicians try to manage spinal headaches conservatively before turning to an invasive treatment. Double check a few things before coding the blood patch procedure:

• Ensure that what you call a blood patch wasn’t simply injecting blood through the epidural catheter before removing it after labor and delivery. If this is the case, you shouldn’t bill the injection separately.

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Aetna EOB Makes New Mom Feel Like a Babe in the Woods

Posted on 27. May, 2009 by .

If you’d like a glimpse of what your coding or billing job might feel like to a patient, check out Anna Wilde Matthews’ tale of trying to decipher her $36,625 bill after she vaginally delivered a healthy baby. “Bringing my newborn son home was a joy. Figuring out the hospital bill wasn’t,” Matthews writes in the Wall Street Journal.

Follow Matthews as she dissects her bill, wrangles with Aetna’s customer service system, and tries to understand why some seemingly incidental things are so expensive. ”The experience left me befuddled,” she writes.

I’m a little befuddled by some of the story’s details as well, such as a $530.29 epidural tray at Cedars-Sinai Medical Center … More …

Ob-Gyn coding and billing expert Melanie Witt is never befuddled. Get her top-notch diagnosis coding advice on-demand.

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