ICD-10-CM code G96.12 and G96.19 is to be used to describe lumbar epidural fibrosis G89.3 should be used when the epidural injection is given in accordance with NCD 280.14. The KX modifier should be appended to the CPT code when this ICD-10 code is used to indicate thedocumentation supports the NCD requirements for the patient.
Only one (1) unit of 62310, 62311, 62318 or 62319 should be billed and allowed per spinal region [cervical/thoracic, lumbar/sacral (caudal)], no matter how many injections are made in that region. 7. The CPT codes 62310, 62311, 62318, and 62319 each have a bilateral surgery indicator of “0.”
Diagnosis Index entries containing back-references to G83.4: Compression cauda equina G83.4 Lesion(s) (nontraumatic) cauda equina G83.4 Neurogenic - see also condition bladder N31.9 - see also Dysfunction, bladder, neuromuscular ICD-10-CM Diagnosis Code N31.9.
It is not billable. Also, a caudal epidural injection is 62323 not a 64483 and not sure why you would be billing 20552. Epidurals also include fluoroscopy so you wouldn't bill the radiology codes.
62319. ESI continuous infusion or bolus (lumbar or sacral [caudal]).
A transforaminal epidural steroid injection (TFESI) performed at the T12-L1 level should be reported with CPT code 64479.
Caudal injections are a type of epidural injection administered to your low back. The shot contains a steroid that reduces pain and inflammation. Caudal injections are outpatient procedures, meaning you can go home the same day.
CPT codes 64479 and 64483 are used to report a single level injection performed with image guidance (fluoroscopy or CT). CPT codes 64480 and 64484 represent each additional level respectively and should be reported separately in addition to the primary procedure when applicable.
62361 (Implantation or replacement of device for intrathecal or epidural drug infusion; nonprogrammable pump).
Code 72275 is a component of Column 1 code 64483 but a modifier is allowed in order to differentiate between the services provided. Code 96365 is a component of Column 1 code 64483 but a modifier is allowed in order to differentiate between the services provided.
Although both injections aim to relieve pain using a steroid solution, each one is administered differently. An epidural is injected into the epidural space, the area that surrounds the dura san, the protective tube of the nerve roots. A caudal nerve block is injected into a specific nerve root in the tailbone region.
What is a Caudal Epidural injection? There is a small opening right at the base of your spine that permits easy access to the epidural space within the spine. This is called the Caudal (sacral) hiatus.
Caudal epidural block is a commonly used technique for surgical anesthesia in children and chronic pain management in adults. It is performed by inserting a needle through the sacral hiatus to gain entrance into the sacral epidural space.
CPT® code 96372: Injection of drug or substance under skin or into muscle.
Coding Guidelines CPT codes 63650, 63655, and 63661-63664 describe the operative placement, revision, replacement, or removal of the spinal neurostimulator system components to provide spinal electrical stimulation.
CPT code 64483 will be reported for service when the physician injects an anesthetic agent(s), steroid, and/or injection(s) transforaminal epidural with imaging guidance (CT or Fluoroscopy) to the Lumbar or sacral region on a single level.
CPT codes, descriptions and other data only are copyright 2020 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.
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This Billing and Coding Article provides billing and coding guidance for Local Coverage Determination (LCD) L39054 Epidural Procedures for Pain Management. Please refer to the LCD for reasonable and necessary requirements.
It is the provider’s responsibility to select codes carried out to the highest level of specificity and selected from the ICD-10-CM code book appropriate to the year in which the service is rendered for the claim (s) submitted.
Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type.
Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination.
This clinical policy references Current Procedural Terminology (CPT®). CPT® is a registered trademark of the American Medical Association. All CPT codes and descriptions are copyrighted 2019, American Medical Association. All rights reserved. CPT codes and CPT descriptions are from the current manuals and those included herein are not intended to be all-inclusive and are included for informational purposes only. Codes referenced in this clinical policy are for informational purposes only. Inclusion or exclusion of any codes does not guarantee coverage. Providers should reference the most up-to-date sources of professional coding guidance prior to the submission of claims for reimbursement of covered services.
Epidural steroid injections have been used for pain control in patients with radiculopathy, spinal stenosis, and nonspecific low back pain , despite inconsistent results as well as heterogeneous populations and interventions in randomized trials. Epidural injections are performed utilizing three approaches in the lumbar spine: caudal, interlaminar, and transforaminal. Generally, candidates for epidural steroid injection are individuals who have acute radicular symptoms or neurogenic claudication unresponsive to traditional analgesics and rest, with significant impairment in activities of daily living.
** Labor epidural provided by the surgeon must be billed with the appropriate delivery anesthesia code and modifier 97. Labor epidural provided by the anesthesiologist and/or CRNA must be billed with the appropriate **0** anesthesia code
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 – Average fee amount $230 – 260
The 64479 code is Unbundled in the CCI Edits from code 62310 (Regular ESI procedure) in the Mutually Exclusive Table of the CCI Unbundling Material. Code 64483 is Unbundled from code 62311 (Regular ESI procedure) in the Mutually Exclusive Table of the CCI Unbundling Material. Therefore, for Medicare and other payors who observe the CCI edits, these codes are not billable together when they are performed at the SAME spinal area. If the physician does an ESI (62311) at level L5 and a Transforaminal ESI (64483) at area L4-5, the procedures are Unbundled and not both billable – only code 62311 would be billable in that case. However, if the physician does an ESI (62311) at level L5 and a Transforaminal ESI (64483) at area L3-4, then it is allowable to put a -59 Modifier on the 64483 code and bill it as the 2nd code following the 62311 ESI code on the claim form.
Epidural injections are used for the treatment of multiple different conditions in chronic and acute pain. Epidural injections may be used for therapeutic and/or diagnostic purposes. There are multiple approaches to epidural injections including caudal, translaminar, and transforaminal.
62311 – 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; lumbar or sacral (caudal) Average fee amount $230 – 260.
1. The HCPCS/CPT code (s) may be subject to Correct Coding initiative (CCI) edits . This policy does not take precedence over CCI edits. Please refer to the current version CCI for correct coding guidelines and specific applicable code combinations prior to billing Medicare.