# Translaminar/Transforaminal Injections



## NESmith (Jan 25, 2011)

I have a provider who did a L4/5 lumbar translaminar epidural steroid injection with use of dye and interpretation of fluoroscopy for level translaminar injection. His procedure notes are as followed: The patient was taken to the injection suite in the office , lying in a prone position. The lumbar spine was draped and prepped in the normal sterile fashion. Biplanar fluoroscopy was used. We anesthetized the skin with 1% lidocaine at L4/5. A Tuohy needle was inserted in the transforaminal position. We aspirated and there was no blood or CSF. radiographic dye was then inserted and the appropriate pattern was seen. Next, 80mg of Depo-Medrol and 2cc of 0.5% marcaine was injected at each level.  
CPT codes billed were:62311 & 77003. Dx 724.4. This is the first time one of my provider has billed CPT code 62311 and I am trying to understand if this is correct. Please help me. Thanks


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## gracigoo (Jan 25, 2011)

*epidural*

i would code it as this if it was TRANSLAMINAR
62311 epidural steroid inj. translaminar
77003 fluoro
J1040 80mg

but i see you put that the note states TRANSFORAMINAL if this is the case i would do this
64483
j1040 80mg
the fluoro is included in the 64483


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## dwaldman (Jan 25, 2011)

62311

The patient is placed in a sitting or lateral decubitus position for the physician to insert a needle into the vertebral interspace of the lumbar or sacral region. The site to be entered is sterilized, local anesthesia is administered and the needle is inserted. Contrast media may be injected to confirm proper needle placement under fluoroscopy. The physician injects a solution to provide a therapeutic or diagnostic outcome. The solution is injected into the epidural or subarachnoid space. With the procedure complete the needle is removed and the wound is dressed.

__________________Abve is from Encoder and below if from AMA

Description of Procedure

An injection needle is directed into the subarachnoid or epidural space at the proper vertebral level, under x-ray fluoros-copy, as necessary. Care is taken to avoid damaging any nerve roots, cauda equina, or the spinal cord. A contrast injec-tion is performed as necessary to confirm the location of the needle tip or catheter and to determine the degree of free flow of liquid in the space to assure both safety and accuracy. The therapeutic injection(s) is performed through the same needle. The injection needle is removed and a sterile dressing applied.

64483

The physician injects anesthetic and/or steroid into the epidural space using a transforaminal approach. This approach is used primarily in the treatment of herniated discs and requires separately reportable fluoroscopic direction. The injection may be performed on a single or multiple lumbar or sacral level. Report 64483 for a single level, report 64484 for each additional level.

__________________Above from Encoder and below AMA


Description of Procedure

Under intravenous anesthetic, the affected foramen is identified and the skin is infiltrated with a local anesthetic. A needle is directed lateral to midline under fluoroscopic guidance into the foramen. Both anteroposterior and oblique or lateral views are needed to get depth as well as an anterior and posterior position. Contrast injection is performed to confirm the location of the needle tip. Once this is completed, an anesthetic agent and/or steroid is injected. The injection needle is removed and a sterile dressing is applied.


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## dwaldman (Jan 26, 2011)

"A Tuohy needle was inserted in the transforaminal position."

This part of the procedure note was confusing when you were saying you were using 62311. 

Then 

"Next, 80mg of Depo-Medrol and 2cc of 0.5% marcaine was injected at each level."

The fact that it says  "each level" and the wording "transforaminal" would make me feel to query the physician that this is not 64483 with possible additional levels (64484 x ) and which sides. The note does not mention the needle entering the intervertebral foramen, but I would still ask him.


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