Wiki 62311 vs 64483

[KKAMMERER]

I have a physician that request 62311 but does 64483 and i have received numerous denials for no authorization and now I have received several request for take backs for no authorization. I am unclear of the difference of these two codes and what to do???

 

[CodingKing]

62311 is Interlaminar ESI
64483 is Transforaminal ESI

As to why they care which one you did, I'm not completely sure. The payer I work for we don't require PA for either and the costs are similar.

 

[Melissa Harris CPC]

If you are receiving an authorization for a lumbar epidural (62311) and the physician is changing the procedure and doing a transforaminal (64483), that is the problem. If the physician changes the procedure at the time of service, he/she needs to notify the staff to initiate an update on the existing authorization to cover a transforaminal. You can try and appeal these denials with documentation why the physician needed to change the procedure and see if they will pay based on medical necessity. The physician may have to amend the procedure note with the reason why he changed the type of injection. These two are different injections.

Hope this helps!

Melissa Harris, CPC
The Albany and Saratoga Centers for Pain Management