# Epidural Steroid Injections



## dyoungberg (Aug 22, 2012)

Medicare patient had:

Therapeutic Fluroscopically guided Transforminal Epidural Steroid Injection at right L4/5

&

Therapeutic Fluroscopically guided lumbar epidural steroid injection at L3/4 & L5/S1

Medicare LCD for 64483 says: _"It is not expected that a patient would undergo an epidural injection at more than two (2) levels (unilateral or bilateral) on any given date of service"_

Can someone tell me if transforaminal and lumbar epidural injection considered one in the same & would be subject to the above LCD guidelines?

When a dr performs 2 different inj types in one day, how does everyone out there deal with this?  Do you go back to the Dr to determine what should be billed or do you not bill anything?

Thanks

Debbie
CPC-A
Billing
NW FL Surgery Center


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## aaron.lucas (Aug 22, 2012)

Epidurals and transforaminal epidurals are NOT the same thing.  The epidural (also called an Interlaminar Epidural) is done with either a midline or paramedian approach, where the needle basically goes straight down in between the vertebrae.  The Transforaminal Epidural is done with an oblique approach, and the target of the needle is just inside the vertebral foramen (a little sleeve that extends over the protruding nerve root, this is actually an extension of the epidural space that protects the nerve root from the surrounding bony structures of the spine.  Typically these are not done in the same operative session, although I wouldn't rule it out completely?  As far as the multiple levels, that also isn't very common for the interlaminar epidurals.  There is an NCCI edit where 64483 is a column 2 code for 62310, but it allows a modifier, not sure how that would work.  Not sure how it should be billed, sorry I can't help more, but hope I at least helped some?


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## dwaldman (Aug 22, 2012)

I think aaron.lucas made some good points in regards to your question. Like he stated, an interlaminar and transforminal is typically not performed during the same encounter. . I would present to the physician the statement about the number of epidurals in a given session and the NCCI edit that bundles 64483/64484 into column one code 62311. I would also point out that the commercial carriers can have a  verison of NCCI that would be stricter with modifier not allowed for this code pair.


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## dyoungberg (Aug 23, 2012)

Thank you both very much.  Your information has helped me quite a bit!  Have a great day!


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