Anesthesia Coding Alert

Question: Our physician used X-ray under fluoroscopy to complete what he called an "epidural catheter placement" for a patient with three fractured ribs. How should I code this?

Indiana Subscriber

Answer: First, check the documentation to verify whether your physician placed an epidural catheter instead of administering a single epidural injection via a temporary catheter, because that difference will guide your coding. You'll also need to know the specific anatomic insertion location because that's what your coding choices center on:

• 62321 – 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, cervical or thoracic; with imaging guidance (i.e., fluoroscopy or CT)
• 62323 – 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); with imaging guidance (i.e., fluoroscopy or CT)
• 62325 – Injection(s), including indwelling catheter placement, continuous infusion or intermittent bolus, of diagnostic or therapeutic substance(s) (e.g., anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, interlaminar epidural or subarachnoid, cervical or thoracic; with imaging guidance (i.e., fluoroscopy or CT)
• 62327 – Injection(s), including indwelling catheter placement, continuous infusion or intermittent bolus, of diagnostic or therapeutic substance(s) (e.g., anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, interlaminar epidural or subarachnoid, lumbar or sacral (caudal); with imaging guidance (i.e., fluoroscopy or CT).

Take note:  In years past, you could report fluoroscopic guidance in addition to the epidural steroid injection (ESI). That changed with the restructuring of ESI codes in 2016, when new codes that were introduced specified whether the provider did or did not use imaging guidance. A separate code for fluoroscopic or CT guidance is no longer allowed with the epidural codes listed here.