# Medical Necessity for billing 62311 and 64483??



## carrollalicia1 (May 9, 2013)

Hi,

I know that per CCI edits that these codes can be unbundled with a modifier, however my question is, Is it really medical necessary to do these both at the same time in the same location. I have attached an op note from my provider. Please assist. I have been seeing this a lot lately  at my practice and want to know if it's appropriate to bill.

Thanks in advance for your assistance. 

Procedure: Lumbar Epidural Steroid Injection 
After a discussion of the risks and benefits, the patient consented to the procedure. The patient was taken to the procedure room and placed in the prone position. The back was prepped with betadine and draped in sterile fashion. A local anesthetic skin wheal was raised with 2cc 1% PF Lidocaine. A Tuohy needle was advanced under fluoroscopic vision and control.  Using a loss of resistance to air technique, the epidural space was accessed at L5/S1, midline. No contrast was administered. Contrast was not administered. Gentle aspiration was negative for blood or cerebrospinal fluid. There was no evidence of nerve root irritation. Following this, I  administered 5cc 1% PF Lidocaine with 80mg DepoMedrol.

Procedure: Lumbar Selective Nerve Root Block (SNRB) 
Next, I advanced a 22-gauge spinal needle, directed at the 12 o'clock position of the pedicle in a straight AP orientation of the fluoroscopy unit. After negative aspiration for blood or CSF, I injected 3cc 1% PF Lidocaine with 40mg DepoMedrol on the right at S1. 
The patient tolerated the procedure well and there were no adverse events noted.  





Assessment 
Lumbar Radiculopathy 724.4



Plan 
Orders: Lumbar epidural steroid injection (62311) - - 05/09/2013 
Fluoroscopic Guidance (77003) - - 05/09/2013 
Lumbar selective nerve root block (64483) - - 05/09/2013 
Instructions: Schedule #2. 
Disposition: Call or Return if symptoms worsen or persist.


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## dwaldman (May 10, 2013)

I would write NCCI and ask them when it is appropriate to add the 59 to 64483 when performed 62311. 

This web page provides information to providers on Medicare's NCCI edits but does not address specific NCCI edits. If the viewer has concerns about specific NCCI edits, he/she may submit comments in writing to:

National Correct Coding Initiative
Correct Coding Solutions LLC
P.O. Box 907
Carmel, IN 46082-0907

Attention:  Niles R. Rosen, M.D., Medical Director and Linda S. Dietz, RHIA, CCS, CCS-P, Coding Specialist

Fax #:  317-571-1745


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## bethh05 (Nov 3, 2015)

I know this is a little late, but if these procedures are performed at the same level they are not separately reported. This is a very helpful link: 
http://www.beckersasc.com/docs/june...s/Sa_a1015_15_CPT_and_Coding_Issues_Ellis.pdf


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