# 62319 vs 62311



## Amanda_Kentch (May 28, 2009)

We are having a probelm deciding when to use 62319 vs 62311.  Which code would you use if the procedure was as listed below.

Caudal area prepped and draped..A skin nick was make and through this a 17 gauge Tuohy needle was advanced into the caudal canal without difficulty..Negative aspiration test was performed and a 19 gauge TeraCath epidural catheter was advanced under flouro...with some manipulation was able to get it up to the L4 level just to the right of the midline. Isovue 200 dye given which showed a good epidurogram with bilateral filling. She was then given 4 ml of 1%lido which was well tolerated...then given 80 mg of triamcinolone to volume 6 ml with saline...Catheter then pulled back into the sacral segment and flushed with 2ml preservative free normal saline....catheter and needle removed intact as a unit. Sterile bandage applied. 


Thanks for looking.
Amanda


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## magnolia1 (May 28, 2009)

62319


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## KimberlyLanier (May 28, 2009)

*62311 vs 62319*

If they used a Catheter for the epidural then you would use 62319, if no Catheter was used then you would use 62311.


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## mattamyc (Dec 2, 2009)

I am having trouble with this one also. Have you found any documentation that states which is correct?  I have searched and have not been able to find anything. I have reports which state a catheter was used and injection given through catheter as intermittent boluses, so I was using 62319.  However, I checked with our experienced coder and she stated the catheter has to be left in to code 62319.


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## Walker22 (Dec 2, 2009)

The use of a catheter does not automatically make it 62319. If you read the description it says, in part, ".. intermittant bolus or continuous infusion...". If only a single dose was given and then the cath was removed, then it should be coded 62311.

I believe 62319 is used mainly by hospitals when they place an epidural cath that's going to remain in place the entire time the patient is there. You would bill 62319 on the first day, and then 01996 once each day afterward until it is removed.

Also, if you read the descriptor for 62311, it specifies "not via indwelling catheter". In the procedure described in the original post, the catheter was temporary, not indwelling, so its fits the definition of 62311.


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## ckkohler (Dec 4, 2009)

I find this discussion rather interesting.  I have 30 years of medical billing/insurance experience - but, have only been a CPC for 1 year ... in my current position, I do not code - and I do work in a pain management clinic/ASC.  As I was learning the whole pain management thing - my DON states the difference between a 62311 and 62319 is the "approach" - all she has said is that the 62319 uses the "tailbone (i.e. caudal) approach" ... so which is correct?


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## Walker22 (Dec 7, 2009)

ckkohler said:


> my DON states the difference between a 62311 and 62319 is the "approach" - all she has said is that the 62319 uses the "tailbone (i.e. caudal) approach" ... so which is correct?



I believe she is mistaken. 62311 and 62319 can _both_ can be performed caudally. It is right there in the descriptor for each if you read the CPT book.


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## CatLaw (Dec 16, 2009)

In my pain practice, we code the caudal as 62311.  The catheter was  not used as continuous infusion.  It was taken out...not kept in place.  You should code it as 62311.


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## Walker22 (Dec 17, 2009)

CathyO said:


> In my pain practice, we code the caudal as 62311.  The catheter was  not used as continuous infusion.  It was taken out...not kept in place.  You should code it as 62311.



exactly


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## brockorama01 (Jan 15, 2010)

I've billing for pain specialists for 15 years and this still makes me pause.

I come down on the side of 62319.  I realize that the code states "intermit bolus", however, the procedure could not be performed as described without a epidural catheter. 

The thicker catheter is used to navigate epidural adhesions from the caudal area to L4.  This is could not be done with a typical epidural needle as typically used in procedures involving 62311.  From an RVU view, the procedure described looks more like a 62319 than a 62311.

Also, given that the physician used saline...could this be Lysis of Epidural Adhesions  62264?

Brock Berta, CPC


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## Walker22 (Jan 15, 2010)

I know what you are saying about the work being more involved, but you must follow the CPT descriptors withhout variation. The descriptor for 62319 _specifies_ intermittant or continous. This does not include single doses, no matter how it is delivered. You could try using the unlisted spinal procedure code 64999 and submitting an op report to see if you can get higher reimbursement. Good luck!

P.S. I am unfamiliar with the standards for 62264, so I will leave that discussion for someone more knowledgeable.

Walker


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## hgolfos (Jan 19, 2010)

You would code as 62311 because the cath was removed immediately, the difference between 62311 and 62319 has nothing to do with the approach.  The difference is: one is continuous and one is a single injection.  If the catheter is left indwelling, even if it's only dosed once or twice, I would bill 62319, but your doc specifically documents that he removed it after a single injection.


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