Wiki Coding for Lumbar Steriod Epidurals and Nerve Blocks

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bcousey26

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Greetings,

I'm recently new to the world of anesthesia and I'm confused on how to determine when to bill for add-on codes that indicate either additional levels. For example: if the provide performed a lumbar steroid epidural at L4-L5 should I bill for 62311 or 62311 in addition to 64480?

How do I know when to bill for the additional or second level add-on code. To those who are guru's in the anesthesia discipline....god bless you.
 
If the technique is translamier you would code 62311. You would not use 64480 as it is add on code for cervical/thoracic transforaminal ESI-64479 is the code for primary procedure. 64483 is for lumbar/sacral transforaminal ESI and 64484 is the add on code for each additional level. Check your physician documentation for the technique used. If it is transforaminal you would code 64483.
 
bcousey26,

Here is an example of when 64483 64484 would be reported. As in your previous post received if you are seeing an epidural descrbing an translaminar or interlaminar then you are only reporting once. What you are need to be able to differ from is a transforminal epidural which as seen below they go per level into the intervertebral foramen for example at L3-L4 and at L4-L5 then you have two codes but this a transforminal technique which is reported per level.



Patient positioned prone,Sterile prep with alcohol, LUMBAR spine prepared, over the shadow of the upper portion of the foramen with left oblique at 15 degrees was marked placing a 25 g 1 1/2 inch needle on tunnel vision directed to left L3-4, and L4-5 foramina, same needle was used to anesthetize tract with lidocaine 1%.
THEN 22 gauge Whitacre tip needle inserted through introducer into the left L3-4, and L4-5 foramen under fluoroscopic guidance. Negative aspiration noted, and Isovue 300 injected shows adequate spread along the left epidural space L3-4, and L4-5 nerve root with some epidural spread medially as well. After negative aspiration, 2 cc of 0.25% Marcaine with 60 mg of DepoMedrol injected at each level.
. No complications noted. RECOVERED WELL, DISCHARGED HOME in stable condition with f/u instructions.
 
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