Neurosurgery 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?

Alabama Subscriber

Answer: As of 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.