Neurology & Pain Management Coding Alert

Proper coding for epidural blocks requires knowledge of the various clinical procedures that may be involved in the patient encounter. Although revisions in CPT 2000 served to simplify these spinal injection codes, the changes have created some confusion in the neurology community. Understanding these changes and procedures will help you achieve proper reimbursement for your neurology practice.

Epidural blocks are used by neurologists for pain management of nonsurgical conditions or, in rare cases, for acute postsurgical pain. The vast majority of these services are for spine-related problems, asserts Francis Lagattuta, MD, chair of the CPT nonoperative coding committee for the North American Spine Society (NASS) and member of the board of directors of the American Association of Electrodiagnostic Medicine (AAEM).

An epidural block involves the use of a needle or catheter to insert a substance into the space surrounding the spinal cord (subarachnoid or epidural). The injections might include one or more substances, such as anesthesia, steroids, antispasmodic or neurolytic agents.

CPT Code Changes

With the changes in CPT 2000, certain codes used to report epidural blocks now are grouped into four families. Probably the most significant change to epidural block coding was the addition of codes 62310-62319 and codes 64479-64484, reports Lagattuta. These two groups of codes are distinguished on the basis of the direction of approach for needle insertion. The new 62310-62319 codes are used to report translaminar epidurals, while the new 64479-64484 codes were created for transforaminal epidurals, he continues.

One thing the new CPT codes were intended to accomplish was simplification in reporting epidural procedures, claims Lagattuta. For this reason, within each of these families (62310-62311, 62318-62319, 62280-62282, and 64479-64484), the codes are differentiated on the basis of location on the spine, whether it be cervical, thoracic, lumbar or sacral.

Of all these epidural block procedures that neurologists might carry out, the majority will be for conditions such as sciatica (724.3) using code 64483 (injection, anesthetic agent and/or steroid, transforaminal epidural; lumbar or sacral, single level). Code 64484 (each additional level) is an add-on code to be reported for every injection given beyond the primary procedure. Similarly, code 64479 describes transforaminal epidurals in the cervical or thoracic region, while 64480 is an add-on code for supplementary injections.

The two families of codes used to report translaminar epidural blocks involving the injection of anesthetics and/or steroids are the new codes 62310-62311 and 62318-62319. Both of these families refer to subarachnoid or epidural injections of substances other than neurolytic agents, reports Karen Duane, CPC, coding specialist for the Barrow Neurological Institute, one of the largest full-service neuroscience centers in the southwestern United States, with 20 neurologists in Phoenix. The new codes replace codes [...]