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Cervical Epidural

  1. #1
    Default Cervical Epidural
    Medical Coding Books
    Our outside coding agency is the following report with 62310. We think it should be coded as 62318. I'd like some feedback, please:


    The patient was placed in the prone position with a pillow underneath the chest and the forehead resting on a headrest. THe neck and upper thorax were prepped and draped in sterile fashion. The flouroscope was placed in the posterior/anterior projection. Lidocaine 1% was used for infiltration through a 27-guage 1-1/2 needle. Using loss of resistance technique, a 17-guage Tuohy cannula was used to enter the cervical epidural space at the C7-T1 level. There were no parethesias reported, nor was there aspiration of CSF or blood. An Arrow radio-opaque Thera-Cath was advanced to the C3 region using flouroscopic guidance. No parethesia was elicited. After negative aspiration for CSF or blood, a continuous infusion of Isovue-M-200 water-soluble dye was used to indentify the bilateral C3-C7 nerve roots and lateral epidural space. The patient received a continuous infusion of 2cc of 1% Lidocaine with 80 mg tramcinolone through the catheter. The catheter and cannula were removed intact. The patient tolerated the procedure well and was brought to the recovery room in stable condition.

    Thanks for you input.

  2. #2
    Location
    Albany, New York
    Posts
    457
    Smile
    I am coming up with 62318 (because of the "infusion").
    Karen Maloney, CPC
    Data Quality Specialist

  3. Default Cervical Epidural
    The documentation states that the catheter was removed intact. I would bill 62310, because it was not left in continuous (for days to come).

    Alicia, CPC

  4. #4
    Default 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.

  5. #5
    Location
    Albany, New York
    Posts
    457
    Default
    In the Coders Desk Reference, description of CPT 62310 does not include "catheter placement", nor does it mention "continuous infusion" as is noted in the Procedure Note in question.
    CPT 62318 reflects both of those terms.
    Karen Maloney, CPC
    Data Quality Specialist

  6. #6
    Default cervical epidural
    I guess I was looking at the time frame. CPT assistant states that 62318 is for intermittent or continuous, but it also says over several hours or days. I guess what we would need then would be the time frame for the procedure. That's what made me think it should be 62310 as this is for a single injection not through indwelling catheter. Since they removed the catheter after, I didn't consider this an indwelling.
    Anyone else?

  7. #7
    Default
    Due to catheter placement and continuous infusion I would bill this as a 62318.

    Julie, CPC

  8. #8
    Location
    St George, UT
    Posts
    37
    Default
    My vote is 62310. Total time of infusion would need to be documented for the 62318 to apply.

  9. #9
    Default on Q Ice
    This is a "62319" procedure that one of our surgeons is wanting start doing. Upon research, per BCBS Anthem, 62319 is only considered medical necessary when both of the foolowing criteria are met
    1. The services are provided by an individual other than the attending physician performing the procedure; and
    2. Alternative types of anesthesia, sedation, or analgesia are not appropriate.

    To me this means that the surgeon mentions above who is an pain managment anestesiolgist can not do the procedure as a treatment for pain.

    Is anyone else that is billing for this procedure as a stand alone procedure being paid?

  10. #10
    Default
    kknapp,

    I believe Anthem BCBS is referring to the regulation when the surgeon places the continuous catheter for postoperative pain management. Below is from the NCCI Policy Manual for Medicare Services.

    "Medicare Global Surgery Rules prevent separate payment for postoperative pain management when provided by the physician performing an operative procedure. HCPCS/CPT codes 36000, 36410, 37202, 62318-62319, 64415-64417, 64450, 64470, 64475, and 90760-90775 describe some services that may be utilized for postoperative pain management. The services described by these codes may be reported by the physician performing the operative procedure only if provided for purposes unrelated to the postoperative pain management, the operative procedure, or anesthesia for the procedure."

    Blocks for postoperative pain management are billable by the anesthesiologist when it is clearly documented that (1) block is for postoperative pain management (2) per the request of the surgeon.

    Julie, CPC
    Last edited by jdrueppel; 02-16-2009 at 12:57 PM. Reason: spelling correction

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