Caudal ESI with ultrsound guidance

pjoos

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What is the correct way to code for a caudal ESI under ultrasound guidance? 62322 , 76942 or 62323?
The current NCCI edits show 76942 to be a column two code for 62322 and a modifier is allowed.
Does the "with imaging guidance" in 62323 include ultrasound?

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
62323 - with Imaging guidance (ie, fluoroscopy or CT)
(Do not report 62323 in conjunction with 77003, 77012, 76942) (I interpret this parenthetical note to apply only to 62323 and to mean you would not report ultrasound if you are reporting fluoroscopy, or CT guidance)

76942 - Ultrasound guidance for needle placement (eg, biopsy, aspiration, injection, localization device), imaging supervision and interpretation
 

dwaldman

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Below is from AMA CPT Assistant September 2017. I think there can be some question how an ultrasound guided injection for a lumbar epdiural is reported, but I think the major roadblock is that the carriers restrict the use of covering a lumbar epidural with ultrasound. I am not aware of a Medicare contractor, UHC, Aetna, BCBS, Cigna, or Humana that cover it.

AMA CPT Assistant Sept 2017
"Spinal injections performed with imaging guidance (fluoroscopy or computed tomography) are now reported with
the new bundled codes, 62321, 62323, 62325, and 62327.

Because these codes are now bundled, no additional codes for imaging guidance should be reported. For spinal injections without imaging guidance, new codes, 62320, 62322,
62324, and 62326 may be reported. (See Figure 1.)"
 
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