# Caudal with Morphine code??



## mickeycoriell (Nov 14, 2012)

Hi, I have an Attending who thinks that we should use a different code when billing for caudal's with morphine. We use 62311 for placing caudals on children when needed for pain managment after surgery. This Attending says that if they place a caudal with morphine, we should use a different code. I found 62318 and wonder if this would be appropriate? 
Any help you can provide is greatly appreciated.
Thanks!


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## Michele Hannon (Nov 14, 2012)

62311 describes a single shot caudal
62318 describes administration via catheter for continuous infusion/intermittent bolus

If indeed this is a single shot caudal you are correct with 62311.


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## Walker22 (Nov 14, 2012)

I agree with Michele. I've been coding for a pain mgmt group for years and 62311 is the correct code. The substance injected does not change the code. He/she (attending) probably thinks that a different code is warranted because of the need for a higher degree of postop monitoring because of the intrathecal morphine, but that is not the case.


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## dwaldman (Nov 14, 2012)

As seen below from AMA CPT Assistant July 2012, the code descriptors for 62310-62319 state the following  non-neurolytic substances injected are recognized and I would believe morphine would fall under injection of opioids. Additionally, it is important to recognize as mentioned in the other responses you received, 62310 and 62311 are for single shot or infusion that is performed in a single calender day. 62318 and 62319 are reserved for catheter that is secured and substances are delivered more than a "single calender day"

.".....therapeutic substance(s) (including anesthetic, antispasmodic, opioid, steroid, other solution),"
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AMA CPT ASSISTANT JULY 2012

The descriptor language for codes 62310 and 62311 was revised and parenthetical instructions were added to denote the difference between a single shot delivery (whether via needle or catheter) and a continuous intermittent bolus delivery (62318, 62319). 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 (eg, as a single injection using either code 62310 or code 62311). 

 62310Injection(s), of diagnostic or   not including neurolytic substances, including needle or catheter placement, includes contrast for localization when performed, epidural or subarachnoid; cervical or thoracic

 62311lumbar or sacral (caudal)

 62318Injection(s), including indwelling catheter placement, continuous infusion or intermittent bolus, of diagnostic or therapeutic substance(s) (including anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, includes contrast for localization when performed, epidural or subarachnoid; cervical or thoracic
 62319lumbar or sacral (caudal)

(For transforaminal epidural injection, see 64479-64484) 

(Report 01996 for daily hospital management of continuous epidural or subarachnoid drug administration performed in conjunction with 62318-62319) 

The epidural injection of a nonneurolytic substance is performed when analgesia is desired mainly in a nerve or nerve root. The subarachnoid injection of a nonneurolytic substance is performed when local anesthesia, analgesia, anti-inflammatory, and/or anti-spasm effects are desired in a nerve, nerve root, or portion of the spinal cord. The subarachnoid route is performed when more specific effects on a desired nerve, nerve root, and/or spinal cord dermatome level are warranted. Again, it is important to note that these codes include the injection of contrast material during fluoroscopic guidance and localization, so the injection of contrast material is not a separately reportable service. 

Coding Tip
Codes 62310 and 62311 should not be reported with code 62318 or code 62319. 
Threading a catheter into the epidural space, injecting substances into one or more levels, and then removing the catheter is considered a single injection and is reported with code 62310 or code 62311. If a catheter is left in place to deliver a substance(s) over a prolonged period of time (ie, more than a single calendar day) either continuously or via intermittent bolus, use code 62318 or code 62319. 

When reporting codes 62310-62319, code selection is based on the region at which the needle or catheter enters the body (eg, lumbar). Codes 62310-62319 should be reported only once when the substance spreads or the catheter tip insertion moves into another spinal region. 

Example:

A 45-year-old male has severe pain (rated at 8 on a scale of 0-10, in which 10 is the worst pain) involving both legs and the lower back after multiple back operations over a 10-year period. Various systemic medications (eg, oral narcotic and nonnarcotic) and physical therapy have all failed to provide long-term pain relief. It is felt that no further operations are likely to provide pain relief. This patient is a good candidate for an epidural narcotic infusion or series of intermittent bolus injections. A continuous infusion of narcotic and local anesthetic can be used for several days during aggressive physical therapy to try and break a cycle of sympathetic dysfunction (eg, from reflex sympathetic dysfunction or complex regional pain syndrome). The catheter can also be used for a series of single injections over several hours or one to two days to test for narcotic pain relief versus pain relief from saline injections. 

How to Code

Code 62318 would be reported if the patient receives an epidural narcotic infusion or a series of intermittent bolus injections in the cervical or thoracic region. 

Code 62319 would be reported if the patient received a subarachnoid narcotic infusion or a series of intermittent bolus injections in the lumbar or sacral region.


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