Anesthesia Coding Alert

Payer policies reveal which conditions indicate medical necessityThe next time you code an epidural steroid injection (ESI), take a closer look at your claim. You could be losing up to $86 if you miss an opportunity to report fluoroscopy code 77003.Use this comprehensive look at coding pain management ESI encounters to be sure you're getting every dime you deserve.Start With 62310-62311The physician likely will choose an interlaminar epidural approach, placing the medicine inside the epidural space. "As long as the needle is positioned in the epidural or subarachnoid space with the needle [inserted] 'straight' in between the lamina," then the following are the correct codes, says Julee Shiley, CPC, CCS-P, CMC, in Raleigh, N.C.:• 62310 -- Injection, single (not via indwelling catheter), not including neurolytic substances, with or without contrast (for either localization or epidurography), of diagnostic or therapeutic substance(s) (including anesthetic, antispasmodic, opioid, steroid, other solution), epidural or subarachnoid; cervical or thoracic• 62311 -- ...lumbar, sacral (caudal).Pay attention: Be careful not to confuse single injection codes 62310-62311 with the following continuous infusion or intermittent bolus codes:• 62318 -- Injection, including catheter placement, continuous infusion or intermittent bolus, not including neurolytic substances, with or without contrast (for either localization or epidurography), of diagnostic or therapeutic substance(s) (including anesthetic, antispasmodic, opioid, steroid, other solution), epidural or subarachnoid; cervical or thoracic• 62319 -- ... lumbar, sacral (caudal).Watch for Transforaminal ApproachIf the physician inserts the needle at an angle into the intervertebral foramen to perform an injection at the nerve root area this is a transforaminal (through the foramen) epidural injection.With this type of epidural, the physician injects the medication into the lateral epidural space "bathing" a specific spinal nerve as it exits the spinal cord. For this approach, you'd use a different set of codes, as follows:• 64479 -- Injection, anesthetic agent and/or steroid, transforaminal epidural; cervical or thoracic, single level• +64480 -- ... cervical or thoracic, each additional level (list separately in addition to code for primary procedure)• 64483 -- ... lumbar or sacral, single level• +64484 -- ... lumbar or sacral, each additional level (list separately in addition to code for primary procedure).Add-on rules: You should report 64479 and 64483 as the primary codes for the first transforaminal injection to the cervical/thoracic or lumbar/sacral levels, respectively. Use add-on codes 64480 and 64484 for each additional injection at the cervical/thoracic or lumbar/sacral levels, respectively.Example: The physician administers transforaminal ESIs at the right L4-L5 and L5-S1 intervertebral spaces, two different levels. You should report 64483 for the first lumbar injection and 64484 for the additional level injection.Find Out if You Qualify for Fluoro CodeIncreasingly, physicians are using imaging guidance to verify precise needle placement for the ESI. You may report fluoroscopic guidance [...]