Anesthesia Coding Alert

Question: Can we use evaluation and management (E/M) codes 99241-99245 (office or other outpatient consultation for new or established patient) for epidural steroid injections and codes 99251-99255 (initial inpatient consultation for new or established patient) for post dural puncture headache consults if we do a steroid injection or epidural blood patch the same day?

Minnesota Subscriber

Answer: Codes 99241-99245 and 99251-99255 used to be known as starred procedures because they included only the procedure, with no preoperative or postoperative care included in the fee. Currently, CPT codes 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) and 62311 (lumbar, sacral [caudal]) are not starred procedures, but 62273 (injection, epidural, of blood or clot patch) is. Whether starred or not, all three of these procedures have zero global days associated with them, which means that visits are separately payable. Therefore, you can bill the appropriate E/M service with a -25 modifier (significant, separately identifiable E/M service by the same physician on the same day of the procedure or other service) along with the procedure code for the epidural injection or blood patch.