The Department of Health and Human Services, Office of Inspector General (OIG) released its report on transforaminal epidural injection services. The OIG stated that Medicare Part B physician payments for transforaminal epidural injections increased almost 150 percent, from $57 million in 2003 to $141 million in 2007.
The OIG audited 433 claim line items from 2007 and extrapolated the results to all transforaminal injection claims for that year. Their findings were as follows:
• 19% of the audited services had a documentation error
• 13% of the audited services had a medical necessity error
• 8% of the audited services had a coding error
• 7% of the audited services had overlapping errors
Based on the extrapolation of the audited claims the report states that 34% of transforaminal epidural injection services allowed by Medicare in 2007 did not meet Medicare requirements, resulting in approximately $45 million in improper payments.
The OIG recommendations to CMS (Medicare) include provider education about proper documentation and strengthening program safeguards to prevent improper payment for these services (including developing Local Coverage Determinations (LCDs), implementing coding edits, and performing medical reviews). To review the full report, please click here.
ISIS has been working through the AMA CPT and RUC Committees on the proper nomenclature for the transforaminal injection codes and ISIS members are strongly encouraged to familiarize themselves with their Local Medicare Coverage Determinations to assure proper coding and billing, as well as meeting the documentation requirements for these services. Please look for additional information from ISIS regarding coding of these procedures coming soon!