Anesthesia Coding Alert

Question: My physician requested approval for 62322, but actually performed the service of 64483 instead. I’ve received numerous denials for “no authorization” and now have received several requests for “take backs for no authorization.” I am unclear on the difference between these two codes. What should I do?

Vermont Subscriber

Answer: The codes you mention represent different types of epidural steroid injections (ESIs). Code 62322 (Injection[s], of diagnostic or therapeutic substance[s] [e.g., anesthetic, antispasmodic, opioid, steroid, other solution], not including neurolytic substances, including needle or catheter placement, interlaminar epidural or subarachnoid, lumbar or sacral [caudal]; without imaging guidance) is an interlaminar ESI. Code 64483 (Injection[s], anesthetic agent and/or steroid, transforaminal epidural, with imaging guidance [fluoroscopy or CT]; lumbar or sacral, single level) is a transforaminal ESI.

If you have authorization for a lumbar epidural (62322) and the physician changes the procedure an administers a transforaminal epidural (64483) instead, that is the problem. If the physician changes the procedure at the time of service, he needs to notify the staff to initiate an update on the existing authorization to cover a transforaminal.

For your existing claims, you can try to appeal the denials with documentation showing why the physician needed to change the intended procedure. The insurer may – or may not – pay for the claim based on medical necessity. Before you appeal the denial, your physician might need to amend the procedure note with the reason why he changed the type of injection.