# Epidural Injection vs Transforminal Epidural



## dyoungberg

My doctor performed Lumbar Epidural Steroid Injection at L4-5 and Transforaminal Lumbar Epidural Steroid Injection at L5 and S1 on left side.  I submitted this to Medicare with codes 62311, 77003, 64483 lt, 64484 lt.  Medicare came back and paid for 62311 and 64484, denying 64483.

It's my understanding that Medicare doesn't pay for 2 different injection types on the same day.  Can anyone tell me if they are correct in paying for 62311 & 64484?  Is it because it is for S1 level?

I appreciate any assistance.


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## dwaldman

64483 is a column two code to column one code 62311 and modifier is allowed. If you didn't apply 59 modifier to indicate it was a separate level 64483 would deny. 

It is my understanding if the needle is placed at the sacral foramen it would be accurate to report 6448X for this service.

Here is a non-published response that is on the AMA CPT Network involving these procedures and additional information I saved from a past webinar.

Date: 06/22/2010 

Surgery 

Nervous System 

Question 

In which instances would it be appropriate to report codes 64483 and 62311 together? 

Answer 

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

__________________________________________________ _______________
Transforaminal/interlaminar

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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## hgolfos

I agree, you need a 59 mod on the first transforaminal level to indicate that it is separate and distinct from the translaminar epidural.


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