Capture  Elements of Spinal Injections and Fluoroscopy

In 2015, the CPT® codebook separated joint injections and aspirations into services “with” and “without” image guidance. This year, CPT® has taken a similar approach with spinal injection services. As of Jan. 1, 62310-63219 are deleted, and replaced with:
62320 Injection(s), of diagnostic or therapeutic substance(s) (eg, anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, including needle or catheter placement, interlaminar epidural or subarachnoid, cervical or thoracic; without imaging guidance
62321 with imaging guidance (ie, fluoroscopy or CT)
62322 Injection(s), of diagnostic or therapeutic substance(s) (eg, anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, including needle or catheter placement, interlaminar epidural or subarachnoid, lumbar or sacral (caudal); without imaging guidance
62323 with imaging guidance (ie, fluoroscopy or CT)
62324 Injection(s), including indwelling catheter placement, continuous infusion or intermittent bolus, of diagnostic or therapeutic substance(s) (eg, anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, interlaminar epidural or subarachnoid, cervical or thoracic; without imaging guidance
62325 with imaging guidance (ie, fluoroscopy or CT)
62326 Injection(s), including indwelling catheter placement, continuous infusion or intermittent bolus, of diagnostic or therapeutic substance(s) (eg, anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, interlaminar epidural or subarachnoid, lumbar or sacral (caudal); without imaging guidance
62327 with imaging guidance (ie, fluoroscopy or CT)
All even numbered codes are without imaging guidance, and all odd numbered codes are with imaging guidance.

New Instructions

CPT® retains the instruction from previous years, “Fluoroscopic guidance and localization is reported with 77003, unless a formal contrast study (myelography, epidurography, or arthrography) is performed, in which case the use of fluoroscopy is included in the supervision and interpretation codes or the myelography via lumbar injection code.” But to aid you with the 2017 code changes, the codebook also now states, “Fluoroscopy or CT and any injection of contrast are inclusive components of 62321, 62323, 62325, 62327.” Parenthetical instructions following each of these codes explain, “Do not report [code] in conjunction with 77003, 77012, or 76942.”
You may report 62320-62327 only once, per session. Code choice is based on the region where the needle enters the body. CPT® instructions also explain that if a catheter is used only for a single day, report the services as if it were a single injection, using 62320-62323. If the catheter is left in place, report 62324-62327 for the initial placement of the indwelling catheter, or for the continuous infusion. Subsequent dates are reported with CPT® 01996 Daily hospital management of epidural or subarachnoid continuous drug administration.

Document to Support the Code

When reporting these codes, you must ensure documentation supports the following five elements:
1. An injection(s) of diagnostic or therapeutic substance(s) – All codes
2. Interlaminar epidural or subarachnoid space – All codes
3. Location of the spine (cervical, thoracic, lumbar, sacral, or caudal)

• Cervical or thoracic codes: 62320, 62321, 62324, 62325
• Lumbar or sacral (caudal) codes: 62322, 62323, 62326, 62327

4. With or without imaging guidance
Without imaging guidance codes:

• Cervical or thoracic: 62320, 62324
• Lumbar or sacral (caudal): 62322, 62326

With imaging guidance codes:

• Cervical or thoracic: 62321, 62325
• Lumbar or sacral (caudal): 62323, 62327

5. Single injection/single day infusion or continuous infusion/indwelling catheter
Single injection/single day infusion codes:

• Cervical or thoracic without imaging guidance: 62320
• Cervical or thoracic with imaging guidance: 62321
• Lumbar or sacral (caudal) without imaging guidance: 62322
• Lumbar or sacral (caudal) with imaging guidance: 62323

Continuous infusion/indwelling catheter codes:

• Cervical or thoracic without imaging guidance: 62324
• Cervical or thoracic with imaging guidance: 62325
• Lumbar or sacral (caudal) without imaging guidance: 62326
• Lumbar or sacral (caudal) with imaging guidance: 62327

When you have identified documentation for all five points, you can report the service properly.

Fluoroscopy Coding Changes

The injection code changes required fluoroscopy codes changes. The CPT® codebook now classifies all fluoroscopy codes (77001-77003) as add-on services. Also updated are the lists of codes that may be reported with CPT® +77002 Fluoroscopic guidance for needle placement (eg, biopsy, aspiration, injection, localization device) (List separately in addition to code for primary procedure) and +77003 Fluoroscopic guidance and localization of needle or catheter tip for spine or paraspinous diagnostic or therapeutic injection procedures (epidural or subarachnoid) (List separately in addition to code for primary procedure). If the procedure code is not listed under the appropriate fluoroscopy add-on code, the fluoroscopy service is not separately reported.

Future of Injection Services

As noted, other blocks and injections (64461-64495) include image guidance, including the transverse abdominis plane blocks (64486-64489) added in January 2015. Given the changes in the 2017 CPT® codebook for fluoroscopy and spinal injections, it’s likely a matter of time before changes are made to nerve block codes 64400-64455, as many providers regularly report the service with CPT® 76942 Ultrasonic guidance for needle placement (eg, biopsy, aspiration, injection, localization device), imaging supervision and interpretation.
Prior to clarifications and code changes in CPT® 2017, reporting fluoroscopy with spinal injections could be tricky. Coders and providers may want to refer to the June 2008 and November 2010 CPT® Assistant for clarification on fluoroscopy services reported through Dec. 31, 2016.
 

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Michael Strong

Michael Strong, MSHCA, MBA, CPC, CEMC, is the bill review technical specialist at SFM Mutual Insurance Company. He is a former senior fraud investigator, with years of experience performing investigations of fraud and abuse. Strong also is a former EMT-B and college professor of health law and communications. He is a member of the St. Paul, Minn., local chapter, and can be contacted at michaelallenstrong@yahoo.com.

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