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62319 vs 62311

  1. #1
    Default 62319 vs 62311
    Medical Coding Books
    We are having a probelm deciding when to use 62319 vs 62311. Which code would you use if the procedure was as listed below.

    Caudal area prepped and draped..A skin nick was make and through this a 17 gauge Tuohy needle was advanced into the caudal canal without difficulty..Negative aspiration test was performed and a 19 gauge TeraCath epidural catheter was advanced under flouro...with some manipulation was able to get it up to the L4 level just to the right of the midline. Isovue 200 dye given which showed a good epidurogram with bilateral filling. She was then given 4 ml of 1%lido which was well tolerated...then given 80 mg of triamcinolone to volume 6 ml with saline...Catheter then pulled back into the sacral segment and flushed with 2ml preservative free normal saline....catheter and needle removed intact as a unit. Sterile bandage applied.


    Thanks for looking.
    Amanda

  2. #2
    Location
    Albany, New York
    Posts
    457
    Default
    62319
    Karen Maloney, CPC
    Data Quality Specialist

  3. Default 62311 vs 62319
    If they used a Catheter for the epidural then you would use 62319, if no Catheter was used then you would use 62311.

  4. Default
    I am having trouble with this one also. Have you found any documentation that states which is correct? I have searched and have not been able to find anything. I have reports which state a catheter was used and injection given through catheter as intermittent boluses, so I was using 62319. However, I checked with our experienced coder and she stated the catheter has to be left in to code 62319.

  5. #5
    Default
    The use of a catheter does not automatically make it 62319. If you read the description it says, in part, ".. intermittant bolus or continuous infusion...". If only a single dose was given and then the cath was removed, then it should be coded 62311.

    I believe 62319 is used mainly by hospitals when they place an epidural cath that's going to remain in place the entire time the patient is there. You would bill 62319 on the first day, and then 01996 once each day afterward until it is removed.

    Also, if you read the descriptor for 62311, it specifies "not via indwelling catheter". In the procedure described in the original post, the catheter was temporary, not indwelling, so its fits the definition of 62311.
    Last edited by Walker22; 12-02-2009 at 03:41 PM.

  6. #6
    Location
    Omaha, Nebraska
    Posts
    149
    Default
    I find this discussion rather interesting. I have 30 years of medical billing/insurance experience - but, have only been a CPC for 1 year ... in my current position, I do not code - and I do work in a pain management clinic/ASC. As I was learning the whole pain management thing - my DON states the difference between a 62311 and 62319 is the "approach" - all she has said is that the 62319 uses the "tailbone (i.e. caudal) approach" ... so which is correct?
    Carolyn Kohler, CPC
    Omaha, NE

  7. #7
    Default
    Quote Originally Posted by ckkohler View Post
    my DON states the difference between a 62311 and 62319 is the "approach" - all she has said is that the 62319 uses the "tailbone (i.e. caudal) approach" ... so which is correct?
    I believe she is mistaken. 62311 and 62319 can both can be performed caudally. It is right there in the descriptor for each if you read the CPT book.

  8. Default
    In my pain practice, we code the caudal as 62311. The catheter was not used as continuous infusion. It was taken out...not kept in place. You should code it as 62311.

  9. #9
    Default
    Quote Originally Posted by CathyO View Post
    In my pain practice, we code the caudal as 62311. The catheter was not used as continuous infusion. It was taken out...not kept in place. You should code it as 62311.
    exactly

  10. #10
    Location
    St. Joseph County, Indiana
    Posts
    101
    Default
    I've billing for pain specialists for 15 years and this still makes me pause.

    I come down on the side of 62319. I realize that the code states "intermit bolus", however, the procedure could not be performed as described without a epidural catheter.

    The thicker catheter is used to navigate epidural adhesions from the caudal area to L4. This is could not be done with a typical epidural needle as typically used in procedures involving 62311. From an RVU view, the procedure described looks more like a 62319 than a 62311.

    Also, given that the physician used saline...could this be Lysis of Epidural Adhesions 62264?

    Brock Berta, CPC

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