Anesthesia Coding Alert

Question: Our pain management specialist administered an interlaminar epidural injection to the patient's T12-L1 joint. Do we consider this a thoracic or lumbar injection for coding?

Wyoming Subscriber

Answer: Consider the procedure a thoracic injection and report 62310 (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; cervical or thoracic).

Explanation: CPT 2010 guidelines mandated that you report 64493 (Injection[s], diagnostic or therapeutic agent, paravertebral facet [zygapophyseal] joint [for nerves innervating that joint] with image guidance [fluoroscopy or CT], lumbar or sacral; single level) for a facet injection to the T12-L1 joint, or nerves innervating that joint. New 2011 guidelines direct you to submit 64490 (Injection[s], diagnostic or therapeutic agent, paravertebral facet [zygapophyseal] joint [for nerves innervating that joint] with image guidance [fluoroscopy or CT], cervical or thoracic; single) instead for a facet injection to the same area. That same mindset " reporting a cervical/thoracic code for a facet injection to T12-L1 also applies to other injection approaches to the vertebral interspace.

Bonus: At first glance, another code choice might be 64479 (Injection[s], anesthetic agent and/or steroid, transforaminal epidural, with imaging guidance [fluoroscopy or CT]; cervical or thoracic, single level). The provider must use a transforaminal approach at the T12-L1 foraminal opening, however, before you can submit 64479.