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Differential Epidural

Maggie Posted Sun 25th of August, 2013 19:23:02 PM

I have done continuous epidural for my patient and injected different concentrations of Marcaine and normal saline to evaluate the response and identify psychosomatic disorder.Total time spent was 3 hours during which patient was evaluated for response and monitoring vital signs.
How should I bill for this procedure.

SuperCoder Answered Tue 27th of August, 2013 00:41:17 AM

My Editor is working on this case. He will revert soon.


SuperCoder Answered Tue 27th of August, 2013 00:41:17 AM
With Apoorba
SuperCoder Answered Tue 27th of August, 2013 01:40:07 AM

Forwarding to Leigh for suggestion. On 08/27, 2:40 am EDT. Amit - plz F/U

SuperCoder Answered Wed 28th of August, 2013 03:48:05 AM

First and foremost, it is necessary to ascertain what other services were provided. If the evaluation only included using the epidural, again depending on how (needle or indwelling catheter) and where the epidural was given, codes 62310, 62311, 62318 or 62319 can be reported.

An appropriate E/M code can be selected to report the evaluation of the patient, if there was any evaluation and management of the patient apart from the epidural. However, if the date of service was after July 1, it is important to note that there is a CCI edit that bundles these services along with E/M codes (with modifier indicator 1) wherein you cannot report the E/M service separately with these codes.

Depending on the typical time of the E/M code selected and how much of the three hours was spent in evaluation and management, they may also be able to report a prolonged services code (or two) from the range 99354-99357.

Finally, there is a HCPCS code for Marcaine HCL (S0020) and one for saline (A4217), which may or may not be reportable, depending on the payer requirement and the circumstances.

SuperCoder Answered Wed 28th of August, 2013 03:49:59 AM

Cleared on 08/28, @ 3.50 am EDT, based on replies from Sachin, Kent Moore.

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