Anesthesia Coding Alert

Question: Most of our carriers consistently deny our claims with 62311. The physician marks all the charge tickets and tells me which modifier to use. What am I doing wrong?

Utah Subscriber

Answer: The problem might not be that you're reporting 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, opioid, steroid, other solution], epidural or subarachnoid; lumbar, sacral [caudal]) for the epidural.

Instead, the problem might lie with your diagnosis code. Many carriers (such as Empire Medicare and HGSA) have specific diagnoses that support medical necessity for procedures, so check whether this is the case with the carriers in question.

Since so many carriers are denying the claims, there might also be a "hidden" problem such as an incorrect type-of-service or place-of-service code. Procedure frequency could be another reason for denial. Most carriers only allow the physician to administer epidurals at certain intervals (such as injections a week apart, and only three injections over a six-month period). Carrier policies regarding epidural administration vary, so check the individual carriers' policies to determine the root of the problem.