You Be the Coder:
Epidural Steroid Injections
Published on Sat Apr 01, 2000
Test your coding knowledge. Determine how you would code this situation before looking at the box below for the answer.
Question: A Rt.L4-5 hemilaminotomy and diskectomy was performed with an epidural steroid injection. After the decompression was completed, a piece of Gelform was placed over the epidural space and 40 mg of Depo-Medrol was administered. The wound was then closed. Can we bill for the epidural steroid injection?
Voncille Johnson
University of Iowa Hospital & Clinics/Neurosurgery Iowa City, Iowa
Answer:,/B> Yes, neurosurgeons can be reimbursed for the injection. Eric Sandham, CPC, compliance educator for Central California Faculty Medical Group, the teaching physicians associated with the University of California at San Francisco in Fresno, states that in the past, the national Correct Coding Initiative (CCI) guidelines rebundled epidural steroid injection code 62289 (injection of substance other than anesthetic, antispasmodic, contrast or neurolytic substance; lumbar or caudal epidural) into almost all laminectomy and spinal procedures. But this code has been deleted and replaced by code 62311 (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; lumbar, sacral [caudal]). The most recent CCI list (April 2000) shows this new code as a component of only code 62319 (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; lumbar, sacral [caudal]) and doesnt list it as bundled into any other laminectomy code. By that criteria, a neurosurgeon may be reimbursed for the injection.
Performing this procedure after a hemilaminectomy isnt quite the same as doing it percutaneously, however, which requires careful blind positioning of the needle or with fluoroscopic or radiological guidance. If the injection is billed as part of an open procedure, the -52 modifier (reduced services) should be applied. Denials still may be issued if third-party carriers are following undisclosed black box edits; such denials would have to be fought on a case-by-case basis.
