# 2 Epidurals on the Same Date? - help!



## sarthur (Jan 28, 2015)

My doctor marked two 62311 injections on the same DOS. How would you code from the following dictation? Would a second 62311 charge with the 59 modifier be appropriate as the procedures were lumbar and lumbar/sacral?


Procedure 1: With the patient in the prone position on the fluoroscopy table, the back is prepped and draped in a sterile fashion. All personnel and operator are wearing hats and masks and the operator is utilizing sterile gloves. A #20-gauge Tuhoy needle is placed through a lidocaine skin wheal and under fluoroscopic guidance advanced intralaminar 5-1 right. 0.5ml of water-soluble contrast is injected with no vascular uptake. Injection is made of 40mg Kenalog and 2ml Isovue-M 300. Epidurogram is produced that extends from 4-5 to sacrum. The needle is removed intact.

Procedure 2: With the patient in the prone position on the fluoroscopy table, the back is prepped and draped in a sterile fashion. All personnel and operator are wearing hats and masks and the operator is utilizing sterile gloves. A #20-gauge Tuhoy needle is placed through a lidocaine skin wheal and under fluoroscopic guidance advanced intralaminar 2-3.0.5ml of water-soluble contrast is injected with no vascular uptake. Injection is made of 40mg Kenalog and 2ml Isovue-M 300. Epidurogram is produced that extends from 2-3 to 1-2. The needle is removed intact.

The patient is left in the prone position in good condition. At no time were dysesthesias produced nor was CSF or blood obtained.


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## dwaldman (Jan 28, 2015)

For Medicare or a payer that follow Medicare's medically unlikely edits. You would only report CPT 62311 once.

As seen below Medicare has MUE of 1 for 62311. So they are not going to reimbursed two intralaminar epidurals on the same date of service. I would review this with the physician so he is aware of their policy. The private payers are not going allow two units of service for CPT 62311,

Medically Unlikely Edits*

Facility 1 units of service per day under most circumstances  
Professional 1 units of service per day under most circumstances  
DME N/A


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## sarthur (Jan 29, 2015)

Thanks, dwaldman. That's what I thought but I wanted to make sure I was correctly understanding whether the injection in between L5 and S1 was enough to say it was in the sacral region and thus could have a 59 to separate it from the injection strictly in the lumbar region. Or at least be a fight worth fighting with an insurance company.


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## dwaldman (Feb 3, 2015)

62311 Injection(s), of diagnostic or therapeutic substance(s) (including anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, including needle or catheter placement, includes contrast for localization when performed, epidural or subarachnoid; lumbar or sacral (caudal)

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AMA CPT Changes 2012

...... placement and use of a catheter to administer one or more epidural or subarachnoid injections on a single calendar day should be reported in the same manner as if a needle had been used, ie, as a single injection using either 62310 or 62311. Such injections should not be reported with 62318 or 62319.......

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The code descriptor for CPT 62311 has injection(s) in the plural form. Additionally CPT Changes 2012 describes one or more epidural injections on single calendar day should be reported as a single injection.


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## sarthur (Feb 3, 2015)

*modifier 22?*

When I told my doctor about the coding rule he responded: "Seems insane the way this was written as many patients who are post laminectimy patients have anatomy that does not allow "spread" through the spine and therefore requires more than one injection..."

Would a modifier 22 be appropriate for the one allowed 62311 charge to demonstrate the extra injection because the anatomy did not allow "spread"?


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## dwaldman (Feb 4, 2015)

Although anatomical variants can be a indication for use of modifier 22, if they describe multiple injections/epidurals in a single day would be reported as one unit of service. I don't know that it would meet the definition of increased procedure service because it is not exceeding  what is included in one unit of service (eg, multiple injections)


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## sarthur (Feb 4, 2015)

Dwaldman, 
Thank you so much for taking the time to help with all of your responses!


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