Pain Management Coding Alert

Question: A patient visited our office for therapeutic injections of Toradol and Kenalog. Do I report the injection codes or HCPCS medication codes? Would they be billable with an epidural injection?

Oklahoma Subscriber 

Answer: You’ll need to answer several other questions before knowing how to code your claim.  

First, verify whether your physician administered the therapeutic injections separate from the epidural. Some physicians think they can separately bill the injection of local anesthetic used to numb the needle insertion site for an epidural injection, but you cannot. If he administered the therapeutic injections and epidural for separate, documented reasons and in separate anatomic sites, you can code both. 

Depending on your answers to these questions, here are all the potential codes for your claim:

• CPT® 96372 (Therapeutic, prophylactic, or diagnostic injection [specify substance or drug]; subcutaneous or intramuscular) for the therapeutic injections. You can either report the two injections as a single line item with two units or service, or can report each injection as separate line items. If you choose separate lines, append either modifier 59 (Distinct procedural service) or modifier 76 (Repeat procedure or service by same physician) to 96372 on the second line. Choose your modifier based on the payer’s guidelines.
• J1885 (Injection, ketorolac tromethamine, per 15 mg) for Toradol
• J3301 (Injection, triamcinolone acetonide, not otherwise specified, 10 mg) for Kenalog
• 62310 (Injection[s], of diagnostic or therapeutic substance[s] [including anesthetic, antispasmodic, opioid, steroid, other solution], not including neurolytic substances, including needle or catheter placement, includes contrast for localization when performed, epidural or subarachnoid; cervical or thoracic) for a cervical or thoracic epidural injection
• 62311 (... lumbar, sacral [caudal]) for a lumbar or sacral epidural injection. 

Checkpoint: Correct Coding Initiative (CCI) edits bundle 96372 as a component of both the comprehensive epidural injection codes (62310 and 62311). You can bypass the bundling edit if your provider performs the therapeutic injection at a separate session, separate anatomic location, etc., and documents his service clearly.