Wiki Epidural Steroid Injections

[stacymhennessey]

I am in an ASC. We have a doc who did epidural steroid injections in both the cervical and the thoracic regions (w/ fluoroscopic guidance).

When I coded it I did 62321 and 62321-59 with different dx codes for each section, but the claim was rejected by Medicare (Palmetto) because the "the information submitted does not support this many/frequency of services."

Since the wording states cervical or thoracic, I went w/ the separate procedure modifier because it was 2 different injections on 2 different parts of the spine, even though they are lumped into one code. Would you appeal the claim determination with the op notes, or is there some other way that I should be coding/billing this?

Thanks in advance!

 

[thomas7331]

Medicare has an MUE edit of 1 set for this codes based on clinical data. I actually code a lot of these, and have never seen more than one interlaminar injection done on the same date. Usually if multiple levels are injected, it is either a transforaminal injection (64479-64484) or a facet joint injection (64490-64495) rather than interlaminar. So my first thought would be to verify that the code is correct or that the physician has dictated this correctly, and if in fact it is the unusal case of a multiple interlaminar injections, then you should be able to appeal this with the records since the edit is not based on a code limitation but rather on the usual clinical frequency of the procedure.

 

[pscanlan]

From the 2019 AMA CPT manual, pp.423: "When reporting 62320-62327 code choice is based on the region at which the needle or catheter entered the body. Codes should be reported only once, when the substance injected spreads or catheter tip insertion moves into another spinal region (eg, 62322 is reported only once for injection or catheter insertion at L3-4 with spread of the substance or placement of the catheter tip to the thoracic region)."

So there are two interpretations for that remark code as I see it. Either you're only allowed one ESI per day, full stop. Or you're only allowed one ESI per percutaneous puncture (phrased funny, but you get my meaning I'm sure). If the spine segments named in the DX codes are touching, Palmetto may think you're trying to get paid twice for treating two areas with a single puncture. If you actually did two punctures, you'll probably need to resubmit/appeal with medical records. Either way, you'll need to find an LCD or Palmetto policy explaining exactly what "frequency" of injections is allowed.

 

[stacymhennessey]

Thanks to you both!

 

[stacymhennessey]

Medicare has an MUE edit of 1 set for this codes based on clinical data. I actually code a lot of these, and have never seen more than one interlaminar injection done on the same date. Usually if multiple levels are injected, it is either a transforaminal injection (64479-64484) or a facet joint injection (64490-64495) rather than interlaminar. So my first thought would be to verify that the code is correct or that the physician has dictated this correctly, and if in fact it is the unusal case of a multiple interlaminar injections, then you should be able to appeal this with the records since the edit is not based on a code limitation but rather on the usual clinical frequency of the procedure.

Our doc does a few of these (where he does multiple injections on the same day) although they are usually in the cervical and the lumbar regions. He hasn't done one that was in both regions mentioned in the single code before.