Orthopedic Coding Alert

Shots for back issues are broken into different groups.

At times, patients with spinal conditions will require epidural injections of opioids, steroids, etc. These injections are broken into two camps: cervical/thoracic and lumbar/sacral.

You’ll need to make sure you choose the proper CPT^® code for these shots in order to preserve reimbursement. Further, you should make sure that the diagnosis is approved by the payer for your patient’s condition before coding.

Take a look at the ins and outs of these types of epidural injections.

Epidurals Often for Patients With Extreme Extremity Issues

Your orthopedist might opt for an epidural for patients with longstanding issues that they have tried to treat more conservatively.

“Usually the patient has been suffering from symptoms for several months or years with pain, numbness of upper or lower extremities, limited motion, difficulty grasping objects or walking, etc.,” says Denise Paige, CPC, COSC, of PIH Health in Whittier, California. If the injections — usually they are done in a series of three — don’t provide long-term relief, then surgery is usually the next step.”

Use These Codes for Cervical/Thoracic Injections

According to Kelly Dennis, MBA, ACS-AN, CAN-PC, CHCA, CPC, CPC-I, owner of Perfect Office Solutions in Leesburg, Florida, when your provider performs a cervical or thoracic epidural injection, you’ll report:

• 62320 (Injection(s), of diagnostic or therapeutic substance(s) (eg, anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, including needle or catheter placement, interlaminar epidural or subarachnoid, cervical or thoracic; without imaging guidance) if the service doesn’t include imaging guidance.
• 62321 (… with imaging guidance (ie, fluoroscopy or CT)) if the service includes imaging guidance.

Important: Your provider might also perform a service represented by the codes for transforaminal epidural injections: 64479 (Injection(s), anesthetic agent and/or steroid, transforaminal epidural, with imaging guidance (fluoroscopy or CT); cervical or thoracic, single level) through 64484 (… lumbar or sacral, each additional level (List separately in addition to code for primary procedure)); and 0228T (Injection(s), anesthetic agent and/or steroid, transforaminal epidural, with ultrasound guidance, cervical or thoracic; single level) through 0231T (Injection(s), anesthetic agent and/or steroid, transforaminal epidural, with ultrasound guidance, lumbar or sacral; each additional level (List separately in addition to code for primary procedure)). For the purposes of this article, however, we’re going to stick with 62320/62321.

Guidance needed when …: “The physician needs a real-time magnified view of the area they are treating. CT [computed tomography] guidance is another option, but I haven’t seen that used in my experience,” says Paige.

Patients who require 62320 or 62321 injections “usually suffer from back or neck pain, limited motion, pain, or numbness in one or both upper extremities,” she says. Also, the provider will have had to try more conservative forms of treatment before opting for the epidural, or the payer could have issues with the claim.

For 62320/62321 patients, “diagnoses vary, but usually the symptoms are due to some form of arthritis or a degenerative disc process with or without myelopathy or radiculopathy,” says Paige.

Some diagnoses that might prove medical necessity for 62320 and 62321 include:

• M47.812 (Spondylosis without myelopathy or radiculopathy, cervical region)
• M47.813 (Spondylosis without myelopathy or radiculopathy, cervicothoracic region)
• M47.814 (Spondylosis without myelopathy or radiculopathy, thoracic region)
• M47.815 (Spondylosis without myelopathy or radiculopathy, thoracolumbar region)
• M50.821 (Other cervical disc disorders at C4-C5 level)
• M50.822 (Other cervical disc disorders at C5-C6 level)
• M50.823 (Other cervical disc disorders at C6-C7 level)
• M51.04 (Intervertebral disc disorders with myelopathy, thoracic region)
• M51.05 (Intervertebral disc disorders with myelopathy, thoracolumbar region)
• M51.14 (Intervertebral disc disorders with radiculopathy, thoracic region).

Note 1: This is not a complete, or approved, list of ICD-10 codes for 62320 and 62321. For more specific education, check your payers’ individual policies before filing the claim. You might also find that different payers have different definitions of “conservative treatments,” which you’ll want to consider to be sure that your epidural injection claim sails through.

Use These Codes for Lumbar/Sacral Shots

When the provider opts for a lumbar/sacral injection, you’ll opt for one of the following codes:

• 62322 (Injection(s), of diagnostic or therapeutic substance(s) (eg, anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, including needle or catheter placement, interlaminar epidural or subarachnoid, lumbar or sacral (caudal); without imaging guidance) if the service doesn’t include imaging guidance.
• 62323 (… with imaging guidance (ie, fluoroscopy or CT)) if the service includes imaging guidance.

Important: Your provider might also perform a service represented by the codes for transforaminal epidural injections: 64479 through 64484; and 0228T through 0231T. For the purposes of this article, however, we’re going to stick with 62322/62323.

For lumbar/sacral epidural patients, “indications would be ... pain, limited motion, pain or numbness in one or both lower extremities, difficulty walking, etc.,” Paige explains.

Some diagnoses that might prove medical necessity for 62322 and 62323 include:

• M46.27 (Osteomyelitis of vertebra, lumbosacral region)
• M47.15 (Other spondylosis with myelopathy, thoracolumbar region)
• M47.16 (Other spondylosis with myelopathy, lumbar region)
• M47.25 (Other spondylosis with radiculopathy, thoracolumbar region)
• M47.26 (Other spondylosis with radiculopathy, lumbar region)
• M47.28 (Other spondylosis with radiculopathy, sacral and sacrococcygeal region)
• M47.815 (Spondylosis without myelopathy or radiculopathy, thoracolumbar region)
• M47.816 (Spondylosis without myelopathy or radiculopathy, lumbar region)
• M47.817 (Spondylosis without myelopathy or radiculopathy, lumbosacral region)
• M47.818 (Spondylosis without myelopathy or radiculopathy, sacral and sacrococcygeal region).

Note 2: Just as with 62320 and 62321, this is not a complete, or approved, list of ICD-10 codes for 62322 and 62323. Check payer policies before filing, and check out what each payer has to say about conservative treatments that lead up to your epidural decision.