cervical epidural
I would use the 62310 see the following 2 CPT assistant Both from 2000.
CPT assistant Jan 2000:
CPT Codes 62318 and 62319
CPT codes 62318 and 62319 describe a continuous infusion or intermittent bolus, including catheter placement of diagnostic or therapeutic nonneurolytic substance(s). CPT codes 62318 and 62319 include the setup and start of the infusion, therefore, these services are not separately reportable. For daily maintenance of the epidural or subarachnoid catheter drug administration, it is appropriate to report code 01996, Daily management of epidural or subarachnoid drug administration, separately.
Clinical Vignettes
A 45-year-old male has severe pain (rated at 8 on a scale of 0-10, where 10 is the worst pain) involving both legs and the lower back after multiple back operations over a 10 year period. Various systemic medications (oral narcotic and nonnarcotic) and physical therapy have all failed to provide long-term pain relief. It is felt that no further operations are likely to provide pain relief.
62318 and 62319
This patient is a good candidate for an epidural narcotic infusion or series of intermittent bolus injections. A continuous infusion of narcotic and local anesthetic can be used for several days during aggressive physical therapy to try and break a cycle of sympathetic dysfunction (eg, from reflex sympathetic dysfunction or complex regional pain syndrome). The catheter can also be used for a series of single injections over several hours or 1-2 days to test for narcotic pain relief versus pain relief from saline injections. For 62319, the patient receives a subarachnoid narcotic infusion or a series of intermittent bolus injections in the lumbar, sacral region.
Description of Procedure
A catheter is threaded through the needle and placed in the subarachnoid space. Through this catheter, a continuous infusion is started for several hours or several days. Occasionally, as part of a detailed diagnostic or treatment regimen, multiple (3 or more) injections might be given through this catheter over a period of hours or 1-2 days. These multiple injections often involve different substances, such as placebo injection or varying amounts of narcotic.
A catheter is threaded through the needle and placed in the epidural space. Through this catheter, a continuous infusion is started for several hours or days. Occasionally, as part of a detailed diagnostic or treatment regimen, multiple (3 or more) injections might be given through this catheter over a period of hours or 1-2 days. These multiple injections often involve different substances, such as placebo injection or varying amounts of narcotic.
ALSO:
Injection, Drainage, or Aspiration Guidelines
In CPT 2000, the guidelines were revised to state: "Injection of contrast during fluoroscopic guidance and localization is an inclusive component of codes 62270-62273, 62280-62282, 62310-62319. Fluoroscopic guidance and localization is reported by code 76005, unless a formal contrast study (myelography, epidurography, or arthrography) is performed, in which case the use of fluoroscopy is included in the supervision and interpretation codes.
Note from 3M:
As of January 1, 2007, 76005 has been deleted. To report, use new code 77003.
For radiologic supervision and interpretation of epidurography, use 72275. Code 72275 is only to be used when an epidurogram is performed, recorded, and a formal radiologic report is issued.
For codes 62318 and 62319, use code 01996 for subsequent daily management of epidural or subarachnoid catheter drug administration."
Ÿ62310 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
Ÿ62311 lumbar, sacral (caudal)
Ÿ62318 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
Ÿ62319 lumbar, sacral (caudal)
These new codes represent a reordering of the 1999 codes. As part of a larger more logical scheme for spinal injections, all of the existing subarachnoid injection codes and epidural narcotic injection codes were grouped together.
These new codes do not differentiate between types of substances injected (eg, narcotic, anesthetic, steroid, antispasmodic), but rather focus on the route of administration (ie, single injection [not via indwelling catheter] versus continuous infusion or intermittent bolus via catheter). However, it is important to recognize that these new codes exclude injection/infusion of a neurolytic substance, which is reported by codes 62280-62282.