Neurology & Pain Management Coding Alert

In CPT 2000, there are big changesand good newsfor neurologists regarding spinal injection codes, which are used when a physician injects diagnostic or therapeutic substances into the spinal canal. The good news is that 10 codes have been consolidated into four, a simplification that should aid coders. Previously, the codes delineated differences in needle placement, but the new codes in 2000 take that burden off the coder.

New code 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), used for cervical or thoracic procedures, replaces 62274, 62275, 62288 and 62298. Neurologists should use 62311 for lumbar procedures that required 62274 in 1999.

New code 62311 (lumbar, sacral [caudal]) replaces 62278, 62289 and lumbar 62288.

New code 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) replaces 62276 and 62277. For lumbar procedures that used 62276 and 62277 in 1999, neurologists should use 62319 (lumbar, sacral [caudal]). CPT 1999 code 62279 has been deleted and replaced with 62319.

Coding for Fluoroscopic Guidance

The new CPT also clarifies coding for fluoroscopic guidance when it is used in spinal injections. CPT 1999 required neurologists to use 76000, a general fluoroscopy code. Now theyll use 76005 (fluoroscopic guidance and localization of needle or catheter tip for spine or paraspinous diagnostic or therapeutic injection procedures [epidural, transforaminal epidural, subarachnoid, paravertebral facet joint, paravertebral facet joint nerve or sacroiliac joint), including neurolytic agent destruction], a new code designed specifically for spinal injection procedures.

Neurologists who administer nerve blocks will see comprehensive changes in those codes. The codes for paravertebral joint injections (64440-64441) and facet joint injections (64442-64443) have been combined into new groups. The CPT 2000 codes distinguish between cervical/thoracic and lumbar proceduresthere are separate codes for each. CPT 1999 code 64440 is replaced by new codes 64479 (injection, anesthetic agent and/or steroid, transforaminal epidural; cervical or thoracic, single level) and 64483 (lumbar or sacral, single level).

Old code 64441, used for each additional level of 64440, is replaced by CPT 2000 code 64480 (injection, anesthetic agent and/or steroid, transforaminal epidural; cervical or thoracic, each additional level [list separately in addition to code for primary procedure]) and 64484 (lumbar or sacral, each additional level [list separately in addition to code for primary procedure]). Old codes 64442 and 64443, used for facet joint injections, have been replaced by 64475 and 64476. Two more new codes, 64470 (injection, anesthetic agent and/or steroid, paravertebral facet joint or facet joint nerve; cervical or thoracic, single level) and 64472 (cervical or thoracic, each additional level [list separately in addition to code for primary procedure]), help distinguish between cervical/thoracic and lumbar levels.

In addition, CPT 2000 includes a new code for epidurograms72275 (epidurography, radiological supervision and interpretation). Previously, there was no code for an epidurogram, though some carriers paid it as an unlisted radiological procedure.

There also are several notable changes to the nerve conduction codes. 95904, previously used only for sensory nerve studies, now can be used for sensory or mixed studies (sensory or motor). And 95961 has been clarified. Previously, the code covered functional cortical mapping, leaving some neurologists confused about whether it could be used for subcortical mapping. The code now explicitly covers both cortical and subcortical mapping.

Neurology practices that administer sleep tests should note several minor changes regarding 95816 (electroencephalogram [EEG] including recording awake and drowsy [including hyperventilation and/or photic stimulation when appropriate]).

The code still can be used to record hyperventilation and/or photic stimulation, but new wording adds when appropriate. Neurologists should be prepared to document medical necessity when using 95816 in hyperventilation and photic stimulation.