An anatomic spinal region for epidurals is defined as cervical/thoracic (CPT codes 62321, 64479 and 64480) or lumbar/sacral (CPT codes 62323, 64483 and 64484). When the epidural injections (62322-62327) are used for cerebrospinal fluid flow imaging, cisternography (78630), the diagnosis code restrictions in this article do not apply.
When epidural injections (62321, 62323, 64479, 64480, 64483 or 64484) are used for postoperative pain management, the diagnosis code restrictions in this article do not apply. When epidural injection (62323) is used for an implantable infusion pump trial, the diagnosis code restrictions in this article do not apply.
Epidural injections (EIs) have been shown to reduce radicular pain, and their use may have the effect of lowering surgical rates for specific spinal disorders.
Z92.241 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. The 2022 edition of ICD-10-CM Z92.241 became effective on October 1, 2021. This is the American ICD-10-CM version of Z92.241 - other international versions of ICD-10 Z92.241 may differ.
A transforaminal epidural steroid injection (TFESI) performed at the T12-L1 level should be reported with CPT code 64479. When reporting CPT codes 64479 through 64484 for a unilateral procedure, use one line with one unit of service.
ICD-10-CM Codes that Support Medical Necessity G89. 3 should be used when the epidural injection is given in accordance with NCD 280.14.
CPT® 62320 in section: Injection(s), of diagnostic or therapeutic substance(s) (eg, anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, including needle or catheter placement, interlaminar epidural ... more.
62323. Injection(s), of diagnostic or therapeutic substance(s) (eg, anesthetic, antispasmodic, opioid, steroid, other solution), not including. neurolytic substances, including needle or catheter placement, interlaminar epidural or subarachnoid, lumbar or sacral (caudal); with. imaging guidance (ie, fluoroscopy or ct)
Long term (current) use of systemic steroids The 2022 edition of ICD-10-CM Z79. 52 became effective on October 1, 2021. This is the American ICD-10-CM version of Z79.
Coding Guidelines When this injection is administered either unilaterally or bilaterally the injections would be billed by placing J7325 in item 24 (FAO-09 electronically) and listing the total number of mg's administered in the units field.
62321. Injection(s), of diagnostic or therapeutic substance(s) (eg, anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, including needle or catheter placement, interlaminar epidural or subarachnoid, cervical or thoracic; with imaging guidance (ie, fluoroscopy or CT)
CPT code 64493 is defined as an “Injection(s), diagnostic or therapeutic agent paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), lumbar or sacral; single level.” CPT code 64494 is the “second level (list separately in addition to code for primary ...
The CPT codes 64490 and 64493 are intended to be used to report all of the nerves that innervate the first level paravertebral facet joint and not each nerve.
Description. 64450. INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; OTHER PERIPHERAL NERVE OR BRANCH.
Group 1CodeDescription72148MAGNETIC RESONANCE (EG, PROTON) IMAGING, SPINAL CANAL AND CONTENTS, LUMBAR; WITHOUT CONTRAST MATERIAL72149MAGNETIC RESONANCE (EG, PROTON) IMAGING, SPINAL CANAL AND CONTENTS, LUMBAR; WITH CONTRAST MATERIAL(S)3 more rows
Medicare will cover epidural steroid injections as long as they're necessary. But, most orthopedic surgeons suggest no more than three shots annually.
ICD-10 Code for Spinal and epidural anesthesia-induced headache during the puerperium- O89. 4- Codify by AAPC.
CPT® 62273, Under Injection, Drainage, or Aspiration Procedures on the Spine and Spinal Cord.
Another spinal injection code, CPT 62273, is available for epidural blood patch.
An epidural block is a numbing medicine given by injection (shot) in the back. It numbs or causes a loss of feeling in the lower half of your body. This lessens the pain of contractions during childbirth. An epidural block may also be used to reduce pain during surgery on the lower extremities.
CPT codes, descriptions and other data only are copyright 2021 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.
Title XVIII of the Social Security Act, Section 1833 (e) states that no payment shall be made to any provider of services or other person under this part unless there has been furnished such information as may be necessary in order to determine the amounts due such provider or other person under this part for the period with respect to which the amounts are being paid or for any prior period..
This Billing and Coding Article provides billing and coding guidance for Local Coverage Determination (LCD) Epidural Steroid Injections 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.
CPT codes for epidural steroid injections are reported from the range 62320-62327 and are divided along three criteria; Method of administration, anatomic site, and use of imaging guidance.
Anatomic site:Within the groups of codes for each administration method, codes are differentiated by cervical or thoracic epidural space (62320-62321, 62324-62325) and lumbar or sacral epidural space (62322-62323, 62326-62327).
For example, if lidocaine is injected along with dexamethasone the final code for the lidocaine injection would be 3E0R3BZ, with the 6th character of “B” specifying that the substance administered is a local anesthetic.
A transforaminal epidural steroid injection (TFESI) performed at the T12-L1 level should be reported with CPT code 64479.
Consistent with the LCD, CPT codes 62321 and 62323 may only be reported for one level per session.
There are currently no U.S. Food and Drug Administration (FDA) approved biologicals for use as an injectable agent into the epidural space or spine. The inclusion of a biological and/or other non-FDA approved substance in the injectant may result in denial of the entire claim based on the CMS IOM Publication 100-02, Medicare Benefit Policy Manual, Chapter 16, Section 180. Amniotic and placenta derived injectants, platelet rich plasma, and vitamins fall into this category.
CPT codes, descriptions and other data only are copyright 2020 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.
This LCD supplements but does not replace, modify or supersede existing Medicare applicable National Coverage Determinations (NCDs) or payment policy rules and regulations for epidural injections. Federal statute and subsequent Medicare regulations regarding provision and payment for medical services are lengthy. They are not repeated in this LCD.
Compliance with the provisions in this policy may be monitored and addressed through post payment data analysis and subsequent medical review audits. History/Background and/or General Information The epidural space lies outside the dural membrane but inside the spinal canal.