Neurosurgery Coding Alert

Question: My surgeon gave a patient two epidural injections of a neurolytic substance. One was at a cervical level, and the other was at the lumbar level. Can I report both injections or should I be using just one code?


Washington Subscriber


Answer: Because the injections were at different levels, you can report both. As long as your physician's documentation supports the different services, report 62281 (Injection/infusion of neurolytic substance [e.g., alcohol, phenol, iced saline solutions], with or without other therapeutic substance; epidural, cervical or thoracic) for the cervical injection and 62282 (... epidural, lumbar, sacral [caudal]) for the lumbar injection.

Tip: The physician's documentation must specify the dosage, location and medical necessity for each injection in order to be eligible for payment.

Payer differences: For some carriers, you-ll need to append modifier 51 (Multiple procedures) to 62282 to indicate to the payer that your surgeon performed more than one service during the same session. Most payers do not require you to append modifier 51 to subsequent line items when your physician performs multiple injections. These insurers will determine your primary and secondary procedures in one of three ways:

- According to the relative value unit (RVU) order based on the Medicare fee schedule
- According to the insurer's own fee schedule
- In the order in which you listed the codes on your claim.

Caveat: Although you can report both injections, don't expect full reimbursement for both services. Because the insurer will discount the second and subsequent procedures, it's best to list the codes in RVU order, with the highest-paying code listed first. Follow this rule of thumb even if your insurer requires you to append modifier 51 before you submit the claim.