Neurology & Pain Management Coding Alert

Question: A patient received an interlaminar epidural block of the lumbar spine with fluoroscopic guidance. I have heard that there are new CPT^® codes for this procedure. How should I code it, and can I include a fluoroscopic guidance code?

Alaska Subscriber

Answer: In 2017, CPT^® deleted code 62311 (Injection[s], of diagnostic or therapeutic substance[s] [including anesthetic, antispasmodic, opioid, steroid, other solution], not including neurolytic substances, including needle or catheter placement, includes contrast for localization when performed, epidural or subarachnoid; lumbar or sacral [caudal]) and replaced it with 62322 (Injection[s], of diagnostic or therapeutic substance[s] [eg, anesthetic, antispasmodic, opioid, steroid, other solution], not including neurolytic substances, including needle or catheter placement, interlaminar epidural or subarachnoid, lumbar or sacral [caudal]; without imaging guidance) and 62323 (... with imaging guidance [ie, fluoroscopy or CT]).

Prior to 2017, you would have been able to bill out for 62311 and +77003 (Fluoroscopic guidance and localization of needle or catheter tip for spine or paraspinous diagnostic or therapeutic injection procedures [epidural or subarachnoid] [List separately in addition to code for primary procedure]) separately. However, with the creation of 62322 and 62323, you now have the option of choosing a code based on whether or not the physician performs imaging guidance.

In this case, you will opt for 62323. If the physician had not performed a corresponding fluoroscopic guidance procedure alongside the epidural block, you would opt for code 62322.