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Anesthesia Coding Alert

READER QUESTION ~ How to Code Epidurals Without Fluoro

Published on Tue Jan 16, 2007

Question: Our physiatrist wants to administer epidurals in our office (a non-surgical facility). Can he perform this service without fluoroscopy (we don't have a fluoroscopy machine)? If so, how should we code it?

Indiana Subscriber
  
Answer: Carriers have different standards for these cases. Some carriers consider fluoroscopy as the standard of care with epidural administration; some require fluoroscopy to prove the physician administered the block and that he delivered the medication to the correct place.

That being said, many carriers will still reimburse the procedure without fluoroscopy. Approved codes often include 64483 (Injection, anesthetic agent and/or steroid, transforaminal epidural; lumbar or sacral, single level) with +64484 (... lumbar or sacral, each additional level [list separately in addition to code for primary procedure]) when appropriate.
 
The carrier might also recognize standard epidural codes 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]) or 62319 (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; lumbar, sacral [caudal]).

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