Anesthesia Coding Alert

Question: Our pain specialist injected a disc's nucleus with an anesthetic agent and a steroid (under fluoroscopy). He performed the discogram for needle placement, not as a diagnostic procedure. How should I code the injection?


Arizona Subscriber

Answer: CPT does not include a code for intradiscal injections, other than the injection procedure for diagnostic discography you report with 62290 (Injection procedure for discography, each level; lumbar) or 62291 (... cervical or thoracic). But you can't report these codes because your specialist did not perform the discography diagnostic study. Instead, you'll report 64999 (Unlisted procedure, nervous system).
 
Set the fee: When you set your fees for the procedure, consider comparing it to either the injection procedures 62290-62291 or 62287 (Aspiration or decompression procedure, percutaneous, of nucleus pulposus of intervertebral disc, any method, single or multiple levels, lumbar [e.g., manual or automated percutaneous discectomy, percutaneous laser discectomy]).

For 2007, 62290 carries 4.54 total relative value units in a facility setting, and 62291 has 4.35 total RVUs. Procedure 62287 has 14.64 total RVUs in a facility (adjust these figures for your geographic area and multiply it by the Medicare conversion factor). Remember that the RVU totals for 62287 represent only one unit of service rather than for each level of injection performed.