Here is some information I have on this, below was from the AMA CPT Network, I don't believe it was published in CPT Assistant, For NCCI they have a mutually exclusive edit with the CPT with the higher RVU being the column two code that would bundle. You could write NCCI and try to get more clarfication or the poise the question to the AMA.
In which instances would it be appropriate to report codes 64483 and 62311 together?
Code 62311, 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; lumbar, sacral (caudal), describes epidural or subarachnoid injections of non-neurolytic substances including opioids, steroids, antispasmodic, and anesthetic substances, and does not differentiate between types of substances injected, but rather focuses 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 code 62311 excludes injection/infusion of a neurolytic substance, which is reported by codes 62280-62282. Therefore, based on the above information and in answer to your specific question, since code 62311 includes the injection of non-neurolytic substances, it would not be appropriate to separately report code 64483, Injection, anesthetic agent and/or steroid, transforaminal epidural; lumbar or sacral, single level.
Below is from a Medtronics 2009 webinar presented by Joanne Mehmert: Pain Management Billing and Coding
Q I have a provider who did a right sided L4-L5 transforaminal epidural steroid injection and interlaminar epidural injection at L4,L5,S1 How would I code for this
A When two different surgical approaches are used to accomplish the same goal, it is not appropriate to report both procedures. In the situation described, the injections are made at the same spinal level, a contiguous anatomical region; it would not be appropriate to report both procedures. A transforaminal epidural 64479/64483 is mutually exclusive to a translaminar epidural 62310/623111.
The CCI shows that a transforaminal epidural 64479/64483 is mutally exclusive to a translaminar epidural 62310/62311. Although a bypass modifier (59) is allowed, the modifier is not appropriate when the injection is at the same spinal level to treat the same condition.
If the provider attempts to perform the injection using the interlaminar technique and finds that the dye does not spread, then changes his/ approach to the transforaminal, only the transforaminal injection should be reported. AMA literature show examples of this coding principle for endoscopic procedures converted to open procedures---report only the "open" code.
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