Epidural steroid injections

[steph2355]

I need some help:

How would I code this;

Caudal Epidural Steroid injection w/Raz catheter?

Thanks.

[rkmcoder]

Sounds like a 62318 or 62319, but you gotta give us more info!

Richard Mann, your pain management coder
rkmcoder@yahoo.com

[dwaldman]

Look at the procedure note and see if there is reference to a single injection (62311) or if the medication was delivered over a period of time like an epidural infusion 62319

[brockorama01]

Also, does the dictation state anything about lysis of epidural adhesions? Generally, the only reason to use a Racz catheter is to lysis adhesions.

[BFAITHFUL]

lysis of adhesions using a RACZ catheter is CPT 62264

[BFAITHFUL]

sorry, first let me clarify my above comment, that is cpt 62264 if neurolytic agent was used, if not used, it would be 62319 for caudal

[cynthiaj54]

Can 72275,26 be billed with 62311?

[debroth_palmenter@yahoo.com]

Can a Caudal Epidural be given without Fluroscopy but US instead or does it require either or one or the other!!!!!!!!!!

Thanks

[dwaldman]

Fluoroscopy (for localization) may be used in the placement of injections reported with 62310 - 62319, but is not required. If used, fluoroscopy should be reported with 77003. For epidurography, use 72275

Above is from AMA CPT Assistant, which states that fluoroscopy guidance is not required. You could review the Medicare carrier's LCD you are billing and the private payers medical policy to double check their stance. I don't recall seeing information in an LCD or medical policy on ultrasound guided epidurals.

[aaron.lucas]

It depends on whether or not the cath was left in after the injection was done. If the cath was removed right after, then 62311 would be correct. If it was left in for continuous infusion or intermittent bolus, then 62319.

For 72275, that can be billed separately, but you would need a complete and separate radiology report to support the epidurography.

Fluoroscopy however doesn't need a separate imaging report as it's just guidance. Billing for the physician is fine, however if you're billing for a facility it may be included in the facility fee, especially common for ASC's, which is where a lot of epidurals are done.

I am kinda surprised that they haven't made fluoro a required component, because I've done some research and according to a lot of studies in 1/3 of all epidurals that do not use flouroscopy, the medication is misplaced...essentially the doctor misses 1 out of every 3 times they don't have some form of guidance. Loss of resistance is great but it's no match for actually seeing where the needle is.