Neurology & Pain Management Coding Alert

Payers hold the key to unlocking medical necessity for these injections It pays to reconsider run-of-the-mill epidural steroid injections (ESIs). If your neurologist uses fluoroscopy in addition to an ESI, you-ll want to be sure you code for it. Otherwise, you risk losing $55 to $95 in additional payouts. Here's a thorough look at coding ESI encounters so you can be sure you-re getting every dime you deserve. Start With 62310-62311 The neurologist 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 going -straight- in between the lamina," then you should choose from the following 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 Approach If the neurologist performs an injection at an angle into the nerve root area outside the epidural space, this is a transforaminal (through the foramen) injection, says Shiley. With this type of epidural, the neurologist injects the medication into the intervertebral foramen "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 neurologist 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 [...]