# unbundling of 62311 with 64483



## Kmatney (Feb 25, 2010)

Based on CCI edits, 62311 & 64483 have an indication of "0" which means a modifier can be added to unbundle these codes. If the injections are performed at separate levels (e.g., 62311 at L2-3 and SNRB at L4-5) can you append a 59 modifier?  I am looking for an example of when it would be appropriate. 
TIA,
Kim


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## hgolfos (Feb 25, 2010)

This code pair has a mutually exclusive edit of "1" not "0"  One means a modifier can bypass.   I think that the best route to take on this would be to ask your physician what he/she is treating with each procedure.  If he/she is using the procedures in a combined technique to treat one problem, I would go with the highest reimbursing.   Otherwise I think you can bill these with a 59 but make sure your documentation reflects very specifically what the physician is treating for each injection.


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## Walker22 (Feb 25, 2010)

It doesn't make any sense to me why you would do these two procedures in the same session. Using your example, if you perform a 62311 at the L2-L3 level, then you would not need to perform a 64483 at L4-L5 because the 62311 provides coverage at the level injected and all levels below that point.


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## Kmatney (Feb 26, 2010)

Thank you for the replies! That is my point exactly... Why would CCI give you the option to add a modifier, if the epidural 62311 would provide coverage at all the levels below?  The purpose of adding the modifier 59 is to indicate that two separate sites were injected.  Both codes are for lumbar/sacral injections, so my thought was if they were performed at two separate levels within the lumbar/sacral area, it would be appropriate to add the 59 modifier.  If it had to be two toally separate spinal regions, it would be a different code.  Does anyone know of an example when it would be appropriate?


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## Walker22 (Feb 26, 2010)

I suppose if the 64483 was given _above_ the site of the 62311 in order give a little additional relief at that particular nerve root, it could be used that way. Although I think most docs would just move the 62311 up a level to cover everything that needs to be covered. Maybe your MD can answer this question.


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## marvelh (Feb 27, 2010)

One scenario that I have seen:  Patient on long-term anti-coagulants that has been taken off to have lumbar epidural procedure...

Therapeutic interlaminar epidural at L3-L4, with injection of contrast and subsequent steroid / local anesthetic injection. Fluoroscopy shows patient has severe stenosis with no flow of contrast below L4 vertebrae.  Code for interlaminar injection = 62311.  

Patient also has symptomatic right L5 radiculopathy which the interventional pain management physician elects to inject at the same session via a right L5-S1 transforminal epidural.  The decision to perform both procedures at same sesion would in part be due to the patient currently being off anti-coagulants for planned interlaminar epidural injection and would be at increased risk for clots if put back on, only to have to come back off for the transforaminal epidural injection on a different date of service to treat the radiculopathy. Code for transforaminal epidural injection = 64483 - 59 - RT.

Interlaminar and transforaminal epidural in the same spinal region as described by CPT code is not common but also not totally unheard of.


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## marvelh (Feb 27, 2010)

Oops forgot to include another scenario for why CCI would allow provider to use a modifer to bypass the bundling edits... cervical interlaminar epidural & thoracic transforaminal epidural or Lumbar interlaminar epidural and sacral transforaminal epidural since both interlaminar ESI and transforaminal ESI codes include 2 spinal regions in their code descriptions - cervical / thoracic and lumbar / sacral.


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## Kmatney (Mar 1, 2010)

Thank you for all the insight regarding these procedures.  It has been very helpful, and greatly appreciated.


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## hgolfos (Mar 2, 2010)

Thank You Marvel!  Your info is very helpful to me also!


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