Neurology & Pain Management Coding Alert

Question: How should I report an intrathecal Baclofen injection our neurologist administered in an outpatient hospital setting?

New Jersey Subscriber
Answer: Your physician is probably performing an intrathecal trial for an implanted infusion pump. Doctors often use Baclofen to treat muscle spasticity associated with multiple sclerosis, cerebral palsy and some spinal- cord injuries. Intrathecal medication administration allows for much lower dosing and potentially fewer side effects due to the lower dosage. Most carriers, however, require some form of trial administration prior to permanent intrathecal infusion pump placement.

Physicians place most intrathecal catheters to infuse in the thoracic or lumbar region. You should check your provider's documentation regarding needle placement for the injection. If he conducted the trial in the thoracic region, look at 62310 (Injection, single [not via indwelling catheter], not including neurolytic substances, with or without contrast [for either localization or epiduro-graphy], of diagnostic or therapeutic substance[s], [including anesthetic, antispasmodic, opioid, steroid, other solution], epidural or subarachnoid; cervical or thoracic).

If your provider administered the injection in the lumbar region, however, report 62311 (... lumbar, sacral [caudal]) instead.

Your physician should not report J0476 (Injection, Baclofen, 50 mcg for intrathecal trial) or J0475 (Injection, Baclofen, 10 mg) because he provided the service in an outpatient hospital setting and did not incur a practice expense for the medication. The facility will report the medication.