Guidelines for Proper Coding of Epidural Steroid Injections (ESIs)
Jeff Majchrzak, BA, (RT)NMTCB
In the 2000 CPT manual, the American Medical As-sociation (AMA) revised many of the codes used to report epidural steroid injections (ESIs), more commonly known as pain management injections. It also added two new code options from the radiology section.
These studies can be performed in either a hospital or freestanding environment by either radiologists or non-radiologists. Up until now, codes 62289 and 62298 were assigned to define these procedures.
62289 Injection of substance other than anesthetic, antispasmodic, contrast or neurolytic solutions; lumbar or caudal epidural (separate procedure)
62298 Injection of substance other than anesthetic, contrast or neurolytic solutions, epidural, cervical or thoracic (separate procedure)
Third-party payers who have not updated their claims processing systems may still require these codes, so be sure to check with yours before you starting using the 2000 codes discussed below.
Billing for ESI Injections
The AMA added the following two new codes for these procedures.
62310 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
62311 lumbar, sacral (caudal)
While the code descriptors above are much longer than the previous options, their actual application is simpler to interpret. The following crosswalk may help.
If you used: Now report:
Note that the new codes define unilateral, single site injections. If injections were performed bilaterally at the same level, a modifier(s) would be needed. Assign either modifier -50 to the surgical code or assign both -LT and -RT. Be certain to verify this requirement with your local third-party payer when billing for bilateral services.
As the code descriptors indicate, the type of material(s) injected usually does not affect code assignment, but there is one exception. If a neurolytic solution is used, do not submit codes 62311 and 62310. More precise code choices for neurolytic injections can be found in the CPT code range 6228062282.
62280 Injection/infusion of neurolytic substance (e.g., alcohol, phenol, iced saline solutions), with or without other therapeutic substance; subarachnoid
62281 epidural, cervical or thoracic
62282 epidural, lumbar, sacral
Billing for Radiology Services
In addition to including new codes for the injection of the materials, the radiology section of the 2000 CPT manual also includes new codes for any type of radiological guidance or radiological imaging performed. The manual includes the following two code options for these studies.
72275 Epidurography, radiological supervision and interpretation
76005 Fluoroscopic guidance and localization of needle or catheter tip for spine or paraspinous diagnostic or therapeutic injection procedures (epidural, transforaminal epidural, subarachnoid, paravertebral facet joint, paravertebral facet joint nerve or sacroiliac joint), including neurolytic agent destruction
The difference between these codes (other than the descriptor length) is as follows.
Code 76005, while not formally cross-walked in the CPT manual, should be used for the fluoro guidance when placing a needle, catheter or other device into epidural or subarachnoid locations for subsequent injections or infusions. (See codes 62318 and 62319.) This code may, and should, be reported separately from the injection procedure(s). Physician dictation and documentation in the report must clarify that fluoroscopic guidance has been utilized.
When a small amount of contrast material is injected prior to the ESI to confirm correct location or position, it is considered part of the study (as the descriptors for code 6231062319 indicate) and not separately identifiable. The only radiology and surgical codes that should be submitted for a unilateral, single level (non-epidurographic) ESI using fluoro guidance are listed below.
* ESI--cervical or thoracic: 76005 and 62310
* ESI--lumbar or sacral: 76005 and 62311
Previously described new code 72275 may also be used for ESIs but, once again, in a very specific fashion. While an epidurography is not performed at a high-volume level, it is a study that, if truly performed, documented and reported, should be billed.
Dorland's Illustrated Medical Dictionary defines epidurography as "radiography of the spine after a radiopaque medium has been injected into the epidural space." Simply defined, this study is analogous to a myelogram.
However, in this instance, the contrast material is not placed in the intrathecal space but in the epidural space. Like a myelogram, images are taken of the flow of the contrast (or lack of flow), and a traditional written report describing the epidurography is made. If all of the steps are performed, code 72275 may be used.
Like myelography, if epidurography is truly performed, recorded and reported, no separate charge for fluoroscopy may be made as this is considered an inherent part of the epidurogram. If no filming of the epidural injection was performed and no written report was issued describing this part of the study, submit only code 76005.
If separate injections were made at the cervical/thoracic and lumbar/sacral levels with epidurography performed at each level, it is appropriate to submit separate charges for each level studied (see AMA CPT Assistant, (10)1, January 2000, page 3).
The correct coding for single level epidurography would be as follows.
* Cervical or thoracic levels: 72275 and 62310
* Lumbar or sacral levels: 76005 and 62311
The correct coding for multiple level epidurography would be as follows. For cervical or thoracic and lumbar or sacral levels, assign codes 72275 (x2), 62310 and 6231.
As described above, the revisions made in this section of CPT should make coding and billing these studies easier for coding and billing staff and also clearer for third-party payers processing these claims. *
Jeff Majchrzak is a senior health care consultant with Medical Learning Inc. (MedLearn), St. Paul, MN.