Neurology & Pain Management Coding Alert

Many factors influence the difficult and critical choice of assigning a CPT code for a spinal injection, and the wrong choice can lead to denials or far-less-than-optimal reimbursement. Spinal injections can be performed for either therapeutic or diagnostic reasons, using neurolytic or non-neurolytic substances. Additionally, a variety of areas in the spine may serve as the injection site. At times it is correct to bill separately for fluoroscopy, while at other times it is not. Spinal injections given at additional levels are sometimes, but not always, reimbursable. By examining key areas of the procedure and working with the neurologist, coding professionals can better determine which code(s) best fits each situation.

Understand How to Code Diagnostic vs. Therapeutic Injections

The first step to coding a spinal injection correctly is to determine whether it was performed for diagnostic or therapeutic purposes. Diagnostic injections such as code 62270 (spinal puncture, lumbar, diagnostic) are used mainly to help identify sources of pain or infection. Code 62263 (percutaneous lysis of epidural adhesions using solution injection [e.g., hypertonic saline, enzyme] or mechanical means [e.g., spring-wound catheter] including radiologic localization [includes contrast when administered]) may also be used for diagnostic purposes for lysis of epidural adhesions. Therapeutic injections like 64400-64484 (anesthetic injections to somatic nerves), 64505-64530 (anesthetic injections to sympathetic nerves), 64600-64680 (neurolytic injections) or 62310-62311 (non-neurolytic epidural injections) are used to relieve pain or muscle spasms.

For example, a patient may have lower back pain (724.2) that physical therapy or other more conservative treatments do not alleviate. The neurologist may decide to perform a diagnostic spinal puncture, lumbar (62270) to aid in diagnosis. In another situation, a neurologist performs four stellate ganglion injections for limb pain (729.5) in a patients arm. He or she uses a single syringe and does not refill it between injections, but simply moves the needle and injects through adjacent skin at the C-6 vertebral level.

This injection would be billed using 64510 (injection, anesthetic agent; stellate ganglion [cervical sympathetic]). With 64510, the stellate ganglion block is used to provide anesthesia to the face, neck and upper extremity, says Sylvia Albert, CPC, president of the Tidewater chapter of the American Academy of Professional Coders (AAPC), and a customer support manager at the AcSel Corp., a physician reimbursement firm in Virginia Beach, Va. Code 64510 is based on the number of injections. If multiple injections are done, it is appropriate to report the code and change the units to refer to the number of nerves injected. But, says Albert, it would not be appropriate to code 64510 with modifier -51 (multiple procedures,). Modifier -51 is applicable when multiple related procedures are performed and there is no single inclusive code available.

Neurolytic vs. Non-neurolytic Substance [...]