Neurology & Pain Management Coding Alert

Question: Our pain management specialist administered an interlaminar epidural injection to the patient's T12- L1 joint. Do we consider this a thoracic or lumbar injection for coding?

Wyoming Subscriber

Answer: Consider the procedure a thoracic injection and report 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).

Explanation: CPT® 2010 guidelines directed providers to report 64493 (Injection[s], diagnostic or therapeutic agent, paravertebral facet [zygapophyseal] joint [or nerves innervating that joint] with image guidance [fluoroscopy or CT], lumbar or sacral; single level) for a facet injection to the T12-L1 joint, or nerves innervating that joint. However, the parenthetical note was revised for 2011 and now directs providers to submit 64490 (Injection[s], diagnostic or therapeutic agent, paravertebral facet [zygapophyseal] joint [or nerves innervating that joint] with image guidance[fluoroscopy or CT], cervical or thoracic; single) instead for a facet injection to the same T12-L1 facet joint. Following that same mindset -- the 2011 CPT® codebook also includes a new parenthetical note directing providers to use 64479 (Injection[s], anesthetic agent and/or steroid, transforaminal epidural, with imaging guidance [fluoroscopy or CT]; cervical or thoracic, single level) for a transforaminal epidural injection at the T12-L1 level. Using these two CPT® directives, it would be reasonable to report the cervical/thoracic region code, 62310, for an intralaminar epidural injection performed at the T12-L1 level.