Radiology Coding Alert

Question: What bundles apply for fluoroscopic guidance and epidural injections?

New Jersey Subscriber

Answer: The new set of bundling edits in CCI 21.2 list epidural codes 62310-62319 as Column 1 with 77003 (Fluoroscopic guidance and localization of needle or catheter tip for spine or paraspinous diagnostic or therapeutic injection procedures [epidural or subarachnoid]) as the Column 2 code. The descriptors for the affected epidural procedures are as follows:

• 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

• 62311 – … lumbar or sacral (caudal) 

• 62318 – Injection(s), including indwelling catheter placement, continuous infusion or intermittent bolus, of diagnostic or therapeutic substance(s) (including anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, includes contrast for localization when performed, epidural or subarachnoid; cervical or thoracic

• 62319 – … lumbar or sacral (caudal).

While the CPT^® descriptors of these codes do not include the image guidance, CMS appears to have pre-emptively bundled the image guidance into this series of codes as well. Since most of these procedures typically require image guidance for confirmation of placement, the work is being considered integral to the procedure and therefore not separately reportable.

The Medicare stance is contradictory to CPT^® directives. Because the first quarter CCI edits for 2015 did not include a bundling edit, some practices mistakenly billed 77003 with these epidural codes and were paid.

You can potentially bypass the bundling edit between 77003 and codes 62310-62319 with a modifier, but the provider would need to use the fluoroscopic guidance with a different procedure from the epidural.