Neurology & Pain Management Coding Alert

Look for documented location, depth and substance

Do you have difficulty selecting the right code for epidural blocks? If so, relax. Choosing the correct code is easy if the neurologist provides complete documentation, coding experts say. You just have to know what you're looking for.

Ask 4 Questions to Narrow Your Choices

When identifying an epidural block procedure, you should search the physician's documentation for four crucial pieces of information. If you can answer the following four questions, you'll stand a better chance of selecting the appropriate code from one of the four epidural block code groups (62280-62282, 62310-62311, 62318-62319 and 64479-64484):

 1. What type of solution did the physician administer (neurolytic [nerve-destroying] or non-neurolytic)?
 2. How did the physician administer the solution (injection or via a catheter)?
 3. To what depth did the physician administer the solution (transforaminal epidural, translaminar epidural, or subarachnoid)?
 4. At what general spinal location (cervical, thoracic, lumbar or sacral) did the physician administer the solution?

Coding experts offer these four guidelines to help you choose the precise epidural block code:
 
1. For Neurolytic Substances, Choose 62280-62282

If your neurologist documents that he used a neurolytic substance, you should automatically turn to codes 62280-62282. All of these codes specify "injection/infusion," but CPT further differentiates among them according to injection/infusion depth and location.
 
Report 62280 for all injections/infusions the physician provides to the subarachnoid space, regardless of the spinal level. The subarachnoid space is the area beneath the arachnoid membrane (the middle of the three coverings surrounding the central nervous system), which lies below the dural layer.
 
If the neurologist specifies injection/infusion to the epidural (rather than subarachnoid) space, you must choose between 62281 and 62282, according to spinal location, says Catherine Brink, CMM, CPC, president of Healthcare Resource Management Inc., a physician practice management consulting firm in Spring Lake, N.J. For injection/infusion to the cervical or thoracic levels, choose 62281. For injection/infusion to the lumbar or sacral (caudal) levels, report 62282.
 
When reporting 62280-62282, you may claim multiple injections by billing multiple units and appending modifier   -51 (Multiple procedures) to the second and subsequent units. For instance, if the neurologist provides two epidural injections of a neurolytic substance - one each at a cervical and lumbar level - you should report 62282, 62281-51. The physician's documentation must independently support the use of each code, outlining the dosage, location and medical necessity for all injections, Brink says.

2. If There's a Catheter, Turn to 62318-62319

If the neurologist administers a non-neurolytic substance (whether an anesthetic, antispasmodic, opioid, steroid or other solution) through an indwelling catheter or bolus, reach for codes 62318/62319, says Francis Lagattuta, MD, an AMA CPT adviser for the North American Spine Society (NASS) and chairman of the NASS Nonoperative Coding Committee. As with 62281/62282, CPT further differentiates 62318/62319 according to the general spinal location the physician injects. For treatment to the cervical or thoracic level, choose 62281. For injections/continuous infusion to the lumbar and sacral levels, report 62282.
 
These codes include use of contrast material for localization or epidurography. Therefore, you should not report contrast separately if the physician employs it, Lagattuta says.
 
For multiple injections/infusions, you should once again report multiple codes and apply modifier -51. For example, the neurologist injects steroids through an indwelling catheter at a cervical and thoracic spinal level. In this case, you should claim 62318, 62318-51.

3. Transforaminal Epidurals Call for 64479-64484

If the physician specifies that he used a transforaminal approach to inject a non-neurolytic substance, you should select an appropriate code from the 64479-64484 grouping, Lagattuta says. Watch your diagnosis here: Physicians use the transforaminal approach most often when treating herniated discs, according to the Coders' Desk Reference. If the neurologist fails to mention use of a transforaminal approach, but you are aware that the injection is for a herniated disk, check with the neurologist before overlooking 64479-64484.
 
For an initial injection at the cervical or thoracic levels, report 64479. For each additional injection at the cervical or thoracic levels, report add-on code +64480. Likewise, for an initial injection at the lumbar or sacral levels, report 64483, and for each additional injection at the same levels, report add-on code +64484. You need not append modifier -51 to the add-on codes 64480 and 64484.
 
For example, Brink says, the neurologist provides transforaminal injections at the C2/C3 and C3/C4 interspaces. In this case, report 64479 for the initial injection and 64480 for the additional injection.
 
You may report fluoroscopy separately with 64479-64484 (see "Make the Most of Block Billing" below for more information).

4. Select 62310/62311 for Translaminar Injection

For single translaminar injections (that is, injections to the epidural or subarachnoid space) of non-neurolytic substances, you should select between 62310 and 62311, depending on location, Lagattuta says. Code 62310 describes injection to the cervical or thoracic levels, and 62311 describes injection of the lumbar or sacral levels. For multiple injections and use of contrast material for localization or epidurography, you should follow the same criteria as for codes 62318/62319, described above.