Submit Clean ESI Claims Every Time -- Including the Fluoro
Published on Tue Sep 23, 2008
Payer policies reveal which conditions indicate medical necessity The next time you code an epidural steroid injection (ESI), take a second look at your claim. If you miss a legitimate chance to report fluoroscopy code 77003, you could be losing $55 to $95, depending on where your office is located. Here's a comprehensive look at coding ESI encounters so you can be sure you-re getting every dime you deserve. Start With 62310-62311 The surgeon likely will choose a translaminar epidural approach, placing the medicine inside the epidural space. Your CPT choices for this ESI include the following: - 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 - 62311 -- -lumbar, sacral (caudal). Medicare assigns 62310-62311 bilateral status indicator "0," which means Medicare will reimburse you for only a single injection even if the surgeon administers bilateral injections. Pay attention: Be careful not to confuse single injection ESI codes 62310-62311 with the following codes for continuous infusion or intermittent bolus: - 62318 -- Injection, including catheter placement, continuous infusion or intermittent bolus, 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 - 62319 -- - lumbar, sacral (caudal). Watch for Transforaminal Approach In some cases, the physician may choose a transforaminal approach. This approach places the medicine outside the epidural space and tracks it into the epidural space at specific levels. For this approach, you-d use a different set of codes, as follows: - 64479 -- Injection, anesthetic agent and/or steroid, transforaminal epidural; cervical or thoracic, single level - +64480 -- - cervical or thoracic, each additional level (list separately in addition to code for primary procedure) - 64483 -- - lumbar or sacral, single level - +64484 -- - lumbar or sacral, each additional level (list separately in addition to code for primary procedure). Add-on rules: You should report 64479 and 64483 as the primary codes for the first transforaminal injection to the cervical/thoracic or lumbar/sacral levels, respectively. Use add-on codes 64480 and 64484 for each additional injection at the cervical/thoracic or lumbar/sacral levels, respectively. Example: The physician administers two lumbar transforaminal ESIs at different levels. You should report 64483 for the first lumbar injection and 64484 for the additional level injection. Bilateral tip: Note that the Medicare physician fee schedule assigns 64479-64484 bilateral status indicator "1." That means that you may report bilateral services, and Medicare will process payment for them. Depending on your payer's preference, [...]
