Anesthesia Coding Alert

Question: When should I use epidural codes 62310-62319? Do they only apply to postoperative pain management?


Florida Subscriber

Answer: Physicians often use epidurals for post-op pain management, but they can also use epidurals for pain management procedures--such as the first intervention to treat a patient's herniated or bulging disks or degenerative disk disease.

If the physician administers a single-shot epidural steroid, report either 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) or 62311 (... lumbar, sacral [caudal]). With these procedures, the physician injects medication directly into the epidural space.

When the medication passes through a catheter rather than being a single-shot injection, you should instead report 62318 (Injection, including catheter placement, continuous infusion or intermittent bolus, 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) or 62319 (... lumbar, sacral [caudal]).

The physician may place the catheter at the time of surgery. If he does, you-ll report an anesthesia code for the surgery. You-ll report the catheter placement (62318 or 62319) separately because the physician will use it for post-op management. Be sure to append modifier 59 (Distinct procedural service) to 62318 or 62319 to show that the physician plans to use the epidural for post-op management instead of during the surgery. Code follow-up days with 01996 (Daily hospital management of epidural or subarachnoid continuous drug administration).
  
Before you code pain management with 62310-62319, verify that the chart includes clear documentation of medical necessity. Many carriers expect certain diagnoses to support these procedures, such as 723.4 (Brachial neuritis or radiculitis NOS) or 724.4 (Thoracic or lumbosacral neuritis or radiculitis, unspecified).

Some carriers (such as the Pennsylvania Medicare carrier HGSA) only want 724.2 (Lumbago) as the supporting diagnosis. Regardless of the carrier's preference, however, always code based on whatever information you have in the medical record and other documentation.