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Facet with an Epidural Injection

  1. Default Facet with an Epidural Injection
    Medical Coding Books

    I was just wondering if it is appropriate to bill out a 3 level facet injection with
    a lumbar epidural injection at the same levels, I'm not seeing any bundles but it dosen't seem quite right ???

    Any advice would be greatly appreciated,


  2. #2
    [I just posted this to another question, but it applies here too]

    Below is a quote from a Medicare LCD (check the LCDs for your jurisdiction).

    "An epidural (62311), transforaminal epidural (64483, 64484), sacroiliac joint injection (27096), or lumbar sympathetic block (64520) should not be performed on the same day as facet joint nerve block injections. Furthermore, only one type of a block or injection should be performed in a given session so that the effectiveness of its treatment can be assessed prior to attempting another type of spinal block or injection."

    Other insurance carriers may have different regulations. So file your claims, wait for the outcomes, then educate your doctors.

    Richard Mann, your pain management coder

  3. Default
    Richard, do you have a link for the above LCD?

  4. #4

    Click on the link above then enter the following information:

    (There may be another page that comes up that wants you to 'ACCEPT')

    Type of Document: Local Coverage Determination
    Geographic Area: New Jersey
    Keyword(s) (title only): (LEAVE THIS BOX EMPTY)
    CPT/HCPCS code: 64490
    Then click "Search Now"

    (You may have to wait a few moments for the search process)

    Click on L27512 for MAC - Part B

    Do a search (CTRL-F) within the LCD for '62311' and you will pop down to the paragraph that I reproduced.

    Richard Mann, your pain management coder

  5. Default
    Hi Richard,

    Thanks so much for responding and providing a link to documentation as well.



  6. Default
    Can an anesthesiologist bill for injection for pain management using start and stop times with code 62311 or should this be billed flat rate as one unit no time involved. This is not post op management, just a single injection for pain management, eg. back problems etc.

  7. #7
    62311 is billed with one unit. The performance of this procedure is not reimbursed per a anesthesia payment formula.

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