Increase Pay Up for Pain Management Spinal Injections
Published on Fri Sep 01, 2000
Spinal injections for pain management can be used in many situations and at a variety of levels. With so many uses available and with the field of pain management and its related codes continuing to grow, selecting the most appropriate code can be a challenge. By examining key areas of the procedure and working with the anesthesia provider, coding professionals can better determine which codes fit each situation best.
Why Is the Injection Done?
The first step to coding a spinal injection correctly is to determine whether it was performed for diagnostic or therapeutic purposes. Diagnostic injections such as code 62270 (spinal puncture, lumbar, diagnostic) are mainly used to help identify sources of pain or infection. Therapeutic injections like codes 64400-64484 (anesthetic injections to somatic nerves), 64505-64530 (anesthetic injections to sympathetic nerves), 64600-64680 (neurolytic injections), or 62310-62311 (non-neurolytic epidural injections) are used to relieve pain or muscle spasms.
For example, a patient may be suffering from back pain that physical therapy or other more conservative treatments may not alleviate. The physician may decide to perform a facet joint injection 64470-64476 (injection, anesthetic agent and/or steroid, paravertebral facet joint or facet joint nerve; various locations and levels) to aid in diagnosis.
This same patient may be a candidate for a series of injections to relieve the back pain. If so, the individual epidural injections with steroids to treat problems such as sciatica may be coded as 62311 (injection, single [not via indwelling catheter], 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; lumbar, sacral [caudal]).
Other codes that may be used for diagnostic purposes include 62270 (spinal puncture, lumbar, diagnostic) to diagnose infection, or 62263 (percutaneous lysis of epidural adhesions using solution injection [e.g., hypertonic saline, enzyme] or mechanical means [e.g., spring-wound catheter] including radiologic localization [includes contrast when administered]) for lysis of epidural adhesions.
What Is Injected?
Second, the coder needs to know what type of substance was injected: a neurolytic or non-neurolytic substance. These can include neurolytic medications such as phenol, alcohol and iced saline or non-neurolytic medications like anesthetics, antispasmodics and steroids.
Non-neurolytic medications are used for temporary pain relief of low back pain, radiating pain or other problems. These can include codes for combination anesthetic/steroid injections such as 62310-62311 and 62318-62319.
Neurolytics (codes 64600-64680) are used for permanent nerve destruction; they kill the nerve rather than simply numbing it. Because of their permanent nature, neurolytic procedures most often are performed when more traditional forms of pain treatment have not alleviated the patients pain. Administering neurolytics carries more risk for the physician and patient alike. As Scott Groudine, MD, [...]
