Anesthesia Coding Alert

Question: We normally bill 62311, 77003, and a J code for epidural injections. A recent Medicare replacement policy has now denied the 77003 as inclusive on some dates of service and paid for other dates of service. The codes are not bundled together per CCI (Correct Coding Initiative) edits. Our LCD (local coverage determination) states that the injection should be given under fluoroscopic guidance if the physician uses a steroid. Has something changed that we’re not aware of?

Arizona Subscriber

Answer: No national policy changes have gone into effect recently. Resubmit your claim with modifier 59 (Distinct procedural service) appended and clear documentation of the injection site. If Medicare still denies the claim, check the LCD billing and coding guidelines. Some payers publish a stance on how to report procedures that include fluoroscopy in the descriptor and those that do not when performed during the same encounter. Also include a separate diagnosis for 77003 (Fluoroscopic guidance and localization of needle or catheter tip for spine or paraspinous diagnostic or therapeutic injection procedures [epidural or subarachnoid]) that matches your diagnosis supporting 62311 (Injection[s], of diagnostic or therapeutic substance[s] [including anesthetic, antispasmodic, opioid, steroid, other solution], not including neurolytic substances, including needle or catheter placement, includes contrast for localization when performed, epidural or subarachnoid; lumbar or sacral [caudal]).