Neurology & Pain Management Coding Alert

Look for documented location, depth and substance Do you have difficulty selecting the right code for epidural blocks? If so, relax. Choosing the correct code is easy if the neurologist provides complete documentation, coding experts say. You just have to know what you're looking for. Ask 4 Questions to Narrow Your Choices When identifying an epidural block procedure, you should search the physician's documentation for four crucial pieces of information. If you can answer the following four questions, you'll stand a better chance of selecting the appropriate code from one of the four epidural block code groups (62280-62282, 62310-62311, 62318-62319 and 64479-64484):

 1. What type of solution did the physician administer (neurolytic [nerve-destroying] or non-neurolytic)?
 2. How did the physician administer the solution (injection or via a catheter)?
 3. To what depth did the physician administer the solution (transforaminal epidural, translaminar epidural, or subarachnoid)?
 4. At what general spinal location (cervical, thoracic, lumbar or sacral) did the physician administer the solution? Coding experts offer these four guidelines to help you choose the precise epidural block code:
 
1. For Neurolytic Substances, Choose 62280-62282 If your neurologist documents that he used a neurolytic substance, you should automatically turn to codes 62280-62282. All of these codes specify "injection/infusion," but CPT further differentiates among them according to injection/infusion depth and location.
 
Report 62280 for all injections/infusions the physician provides to the subarachnoid space, regardless of the spinal level. The subarachnoid space is the area beneath the arachnoid membrane (the middle of the three coverings surrounding the central nervous system), which lies below the dural layer.
 
If the neurologist specifies injection/infusion to the epidural (rather than subarachnoid) space, you must choose between 62281 and 62282, according to spinal location, says Catherine Brink, CMM, CPC, president of Healthcare Resource Management Inc., a physician practice management consulting firm in Spring Lake, N.J. For injection/infusion to the cervical or thoracic levels, choose 62281. For injection/infusion to the lumbar or sacral (caudal) levels, report 62282.
 
When reporting 62280-62282, you may claim multiple injections by billing multiple units and appending modifier   -51 (Multiple procedures) to the second and subsequent units. For instance, if the neurologist provides two epidural injections of a neurolytic substance - one each at a cervical and lumbar level - you should report 62282, 62281-51. The physician's documentation must independently support the use of each code, outlining the dosage, location and medical necessity for all injections, Brink says. 2. If There's a Catheter, Turn to 62318-62319 If the neurologist administers a non-neurolytic substance (whether an anesthetic, antispasmodic, opioid, steroid or other solution) through an indwelling catheter or bolus, reach for codes 62318/62319, says Francis Lagattuta, MD, an AMA CPT adviser for the North American Spine Society (NASS) and chairman of the NASS [...]