# epidurals using theracaths



## karras (Feb 27, 2017)

I've been seeing a lot of epidurals being performed with the use of a theracath.  I've been coding them as injections and not catheter placements.  How are you all coding these?  I got into a debate with someone who thought they should be billed as a catheter placement.  

Thanks.
Kim


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## dwaldman (Mar 5, 2017)

When discussing catheters and epidurals. There would be a couple of codes that could be considered. For example in the lumbar region with fluoroscopic guidance, threading a catheter in the epidural space could potentially fall under 62323, 62327, or 62350.

Starting with CPT 62350 this would be for a tunneled catheter placement for long term medication administration and attached to pain pump to deliver that medications. There would specific instances this would reported.

For 62323 or 62327 which might be more closely related to your question, the main component is if the infusion and or bolus was performed on a single calendar day or more than a single calendar day. It is important to note that both codes include catheter placement and any discussion must reference guidelines in the AMA CPT manual and as also seen in AMA CPT Changes. The medical record would have to be reviewed at the site of insertion to confirm for example lumbar versus thoracic. Additionally appropriate code selection is dependent on knowing if the infusion/bolus single calendar day or longer time frame. 

Below I have provided the CPT codes mentioned in the response, additionally I have provide from AMA CPT Changes 2017 the specific instructions for appropriate code selection.

62323  
Injection(s), of diagnostic or therapeutic substance(s) (eg, anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, including needle or catheter placement, interlaminar epidural or subarachnoid, lumbar or sacral (caudal); with imaging guidance (ie, fluoroscopy or CT)  

62327  
Injection(s), including indwelling catheter placement, continuous infusion or intermittent bolus, of diagnostic or therapeutic substance(s) (eg, anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, interlaminar epidural or subarachnoid, lumbar or sacral (caudal); with imaging guidance (ie, fluoroscopy or CT)  

62350  
Implantation, revision or repositioning of tunneled intrathecal or epidural catheter, for long-term medication administration via an external pump or implantable reservoir/infusion pump; without laminectomy  
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AMA CPT Changes 2017

The 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 62320, 62321, 62322, or 62323. Such injections should not be reported with 62324, 62325, 62326, or 62327.  Threading a catheter into the epidural space, injecting substances at one or more levels and then removing the catheter should be treated as a single injection (62320, 62321, 62322, 62323). If the catheter is left in place to deliver substance(s) over a prolonged period (ie, more than a single calendar day) either continuously or via intermittent bolus, use 62324, 62325, 62326, 62327 as appropriate.  When reporting 62320, 62321, 62322, 62323, 62324,
62325, 62326, 62327 code choice is based on the region at which the needle or catheter entered the body (eg, lumbar). Codes 62320, 62321, 62322, 62323, 62324,
62325, 62326, 62327 should be reported only once, when the substance injected spreads or catheter tip insertion moves into another spinal region (eg, 62322 is
reported only once for injection or catheter insertion at L3-4 with spread of the substance or placement of thecatheter tip to the thoracic region).


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