Wiki Please Help---62310 vs 64479

[jls4567]

Hi there,
I had posted thi in the general discussions thread in error.
I am fairly new to Pain coding and have a physician that is questioning how the following should be coded.
"Cervical epidural steroid injection through the interlaminar route with a catheter going to the transforaminal opening of the left side of c6-C7.
Would this be a 62310 or a 64479?

Any help and back up documentation would be greatly appreciated.
Thank you in advance.

 

[dwaldman]

Below describes the procedure represented by CPT 64483. I believe that if you are using a interlaminar approach (62311) it is based on the approach in this case not the final location of catheter tip is my interpretation. Maybe other forum members would view it differently.

AMA CPT Network
CPT Code: 64483

Clinical Example

A 71-year-old male with coronary artery disease and moderate heart failure presents with recurrent right leg pain, the abil-ity to stand for only 10 minutes and walk less than 1 block, and minimal problems sitting. The patient's history includes a previous laminectomy at L4-L5; a magnetic resonance imaging scan with gadolinium, showing a small recurrent herniation between L4-L5 with scar tissue; and neurodiagnostic studies compatible with an acute L5 radiculopathy. He has failed to obtain relief using various oral medication, physical therapy, and traction. He undergoes a transforaminal epidural injec-tion of an anesthetic agent and/or steroid at the L5-S1 level.

Description of Procedure

Under intravenous anesthetic, the affected foramen is identified and the skin is infiltrated with a local anesthetic. A needle is directed lateral to midline under fluoroscopic guidance into the foramen. Both anteroposterior and oblique or lateral views are needed to get depth as well as an anterior and posterior position. Contrast injection is performed to confirm the location of the needle tip. Once this is completed, an anesthetic agent and/or steroid is injected. The injection needle is removed and a sterile dressing is applied.

 

[dwaldman]

Here is the cervical vignette

CPT Code: 64479

Clinical Example

A 55-year-old male with coronary artery disease and moderate heart failure presents with constant, moderately severe, right arm pain that limits all activity. The patients history includes a laminectomy at C5-C6, a magnetic resonance imaging scan with gadolinium showing a small bony spur at the right C5-C6 foramen compressing the C6 nerve root, and neurodiagnostic studies compatible with an acute C6 radiculopathy. He has failed to obtain relief using various oral medications, physical therapy, and traction. He undergoes a transforaminal epidural injection of an anesthetic agent and/or steroid at the C5-C6 level.

Description of Procedure

Under intravenous anesthetic, the affected foramen is identified and the skin is infiltrated with local anesthetic. A needle is directed lateral to midline under fluoroscopic guidance into the forearm. Both anteroposterior and oblique views are needed to get depth as well as anterior and posterior position. Contrast injection is performed to confirm needle tip location. After this is completed, anesthetic agent and/or steroid is injected. The injection needle is removed, and dressing is applied.

 

[marvelh]

A catheter inserted via an interlaminar approach used to perform an epidural injection & then removed is reported with 62310.

Review the Spine & Spinal CPT Section Guidelines: The placement and use of a catheter to administer one or more epidural or subarachnoid injections on a single calendar day should be reported in the same manner as if a needle had been used, i.e. as a single injection using 62310 or 62311. Threading a catheter into the epidural space, injecting substances at one or more levels and then removing the catheter should be treated as a single injection (62310, 62311)...

 

[aaron.lucas]

I think the main thing you need to look at is what approach did the doctor use? 62310-62311 are performed with a midline/paramedian approach, almost perpendicular to the spine, whereas 64479-64484 are performed with an oblique approach, coming in at an angle and targeting the nerve root sheath where it exits the spine. Look for the approach, and also perhaps if "loss of resistance" is documented. From what I've read loss of resistance isn't possible with transforaminal epidurals because the needle doesn't pass through a sufficiently dense structure for it to work. So if that is documented that could be something else to lean you towards 62310-62311. Maybe sit down with the physician and ask them to more thoroughly explain the procedure and discuss how to document it so it's more clear in the future? Also see if you can find video of each procedure being done, there are some on YouTube that show the different injections and how the approaches and procedures differ. Hope this helps!