Pain Management Coding Alert

Question: There is so much confusion regarding billing 62310 and 62311 with 77003. Some payers say the procedures include fluoroscopic guidance for 2015, but that’s not included in the CPT® explanation. I have also read that the two codes are billable together. We have been billing it and our Medicare carrier has been paying the fluoro for 2015. Should we bundle fluoro with injection code? 

Texas Subscriber 

Answer: There is some confusion about these procedures due to CCI edits that haven’t “caught up” with the final rule in the Federal Register.

The most recent information from Medicare directs that you should not bill epidural injection codes 62310 (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; cervical or thoracic) or 62311 (…lumbar or sacral [caudal]) with guidance code 77003 (Fluoroscopic guidance and localization of needle or catheter tip for spine or paraspinous diagnostic or therapeutic injection procedures [epidural or subarachnoid]). 

Review the section “‘Epidural Injection and Fluoroscopic Guidance—CPT® Codes 62310, 62311, 62318, 62319, 77001, 77002 and 77003” in the Federal Register. According to the final rule, “After considering comments received, we are finalizing CPT® codes 62310, 62311, 62318, and 62319 as potentially misvalued, finalizing the proposed RVUs for these services, and prohibiting separate billing of image guidance in conjunction with these services.” 

So, although your Medicare carrier might process the codes together at this point, there is the potential for retrospective audits that would require repayment.

Another note: Remember that this is a Medicare change. Other pays may still allow fluoroscopy to be billed with codes 62310-62319.