Pain Management Coding Alert

Question: Notes indicate that the PM specialist performed an interlaminar lumbar epidural injection with computed tomography (CT) guidance. I reported 62324 and 77012 and received a denial. what did I do wrong?

Oregon Subscriber

Answer: You should not have reported these codes together, as CPT^® forbids it. When you resubmit the claim, report 62327 (Injection(s), including indwelling catheter placement, continuous infusion or intermittent bolus, of diagnostic or therapeutic substance(s) (eg, anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, interlaminar epidural or subarachnoid, lumbar or sacral (caudal); with imaging guidance (ie, fluoroscopy or CT)) for the service.

Reason: There are codes that represent various epidural injections your provider performs with and without imaging guidance. These codes include:

• 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
• 62323 — … with imaging guidance (ie, fluoroscopy or CT)
• 62324 — Injection(s), including indwelling catheter placement, continuous infusion or intermittent bolus, of diagnostic or therapeutic substance(s) (eg, anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, interlaminar epidural or subarachnoid, cervical or thoracic; without imaging guidance
• 62325 — … interlaminar epidural or subarachnoid, cervical or thoracic; with imaging guidance (ie, fluoroscopy or CT)
• 62326 — … without imaging guidance
• 62327.

As 62323, 62325, and 62327 include guidance, CPT^® forbids you from reporting any of them with any of the following codes:

• +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)
• 77012 — Computed tomography guidance for needle placement (eg, biopsy, aspiration, injection, localization device), radiological supervision and interpretation 
• 76942 — Ultrasonic guidance for needle placement (eg, biopsy, aspiration, injection, localization device), imaging supervision and interpretation.

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