# Transforaminal Selective Epidural Steroid Injections



## NESmith (Jun 11, 2010)

Our physician did a 1. Cervical intraspinal epidurogram injection at left C5-C6 transforaminal levels with interpretation. 2. Catheter-guided transforaminal selective epidural steriod injections at the C5 & C6 transforaminal levels. He is billing 64479-LT
                                          64480-LT
                                          J0702
                                          72275-59
I think this is incorrect because I see only one level. Is C5-C6 only one level? Please help. Thanks


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## rkmcoder (Jun 14, 2010)

(These are my opinions and should not be construed as being the final authority.  Other opinions may vary.)

Please share the operative note.

Richard Mann, your pain management coder
rkmcoder@yahoo.com


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## NESmith (Jun 14, 2010)

Under fluoroscopic visualization, the C7-T1 interspace was delineated and a 25-guauge needle was then used and a positive loss of resistance was obtained using normal saline solution. At this point, an injection of optiray 300 2 cc nonionic contrast dye was performed and contrast was seen to extend through the cervical epidural space. At this point, an Arrow spring-tip flexible catheter was placed under direct fluoroscopic visualization and advanced to the left C5-C6 foramen. After negative aspiration and the patient's denial of any paresthesias, an injection of Optiray 300 0.25-0.5 cc nonionic contrast dye was perfomred at each of the respective levels. For the purpose of diagnosis and interpretatin, hard film copies were taken for the patient's record. 
Cervical transforaminal Epidural Steroid Injections: At that point, we prepared a solution containing 3 cc of preservative-free normal saline and 1 cc or 12 mg of Celestone. Approximately 2 cc of the solution was injected per transforaminal level at the respective levels of left C5 & C6. The cathter and needle were subsequently withdrawn with no evidence of the tip disruption or catheter shearing. All injection sites were sterilely dressed.
I hope this is enough to help. Let me know & Thank You for your help.


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## rkmcoder (Jun 14, 2010)

(These are my opinions and should not be construed as being the final authority.  Other opinions may vary.)

The operative note clears it up.  This is an cervical ESI with catheter - 62318.  Fluoro was used for localization, so use code 77003 and not 72275.  I cannot help you with the drug code.

Richard Mann, your pain management coder
rkmcoder@yahoo.com


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## ASC CODER (Jun 14, 2010)

May I ask why you are billing for the Catheter? It was removed and my understanding is that When a catheter is placed it is for indwelling and continuous infusion or intermittent bolus. Because the catheter was removed it is no longer indwelling. I see catheter placements all the time and they are used for guiding the needle placement. Please let me know if I am wrong.


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## rkmcoder (Jun 14, 2010)

(These are my opinions and should not be construed as being the final authority.  Other opinions may vary.)

If a catheter is threaded from the level that it was inserted up to another level(s), and this new level(s) is/are injected, use the ESI catheter codes 62318 or 62319.  In your code description above you indicate; "...for indwelling and continuous infusion or intermittent bolus."  This is not what the code description says.  Here is the entire description:

"Injection, including catheter placement, continuous infusion or intermittent bolus, 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; cervical or thoracic."

The word 'indwelling' does not appear in the description.  'Continuous infusion' means continuously infusing the medication while pulling the catheter from level to level.  'Intermittent bolus' means stopping the catheter at level(s) to infuse the medication.  So, in other words, 62318 and 62319 are codes for an ESI injection that uses a catheter to infuse different level(s) than the entry point.

Richard Mann, your pain management coder
rkmcoder@yahoo.com


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