Anesthesia Coding Alert

Question: Medicare denies our claim when we bill 62311, 77003, and 64483 together. The physician performs the separate injections on the same day and uses fluoroscopic guidance for the epidural. Medicare denies the CPT 77003 as bundled. We know it is bundled into 64483, but it's not bundled into 62311. How should we handle this situation?

Massachusetts Subscriber

Answer: Assuming the provider performs the epidurals at separate levels, your claim should include three lines:

• 64483 (Injection, anesthetic agent and/or steroid, transforaminal epidural; lumbar or sacral, single level) with modifier 59 (Distinct procedural service) appended
• 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, opiod, steroid, other solution], epidural or subarachnoid; lumbar, sacral [caudal])
• 77003 (Fluoroscopic guidance and localization of needle or catheter tip for spine or paraspinous diagnostic or therapeutic injection procedures [epidural, transforaminal epidural, subarachnoid, or sacroiliac joint], including neurolytic destruction) with modifier 26 (Professional component) and modifier 59.

Resubmit your claim with modifier 59 appended as above and clear documentation of the separate injection sites. If Medicare still denies the claim, check the LCD (local coverage determination) 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 that matches your diagnosis supporting 62311.