icd 9 code for epidural steroid injection with fluoroscopy

Full Answer

What is the CPT code for epidural steroid injection?

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.

What is the diagnosis code for epidural injection 62321?

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.

What is the ICD 10 code for lumbar epidural fibrosis?

*ICD-10 code G96.12 is to be used to describe lumbar epidural fibrosis ICD-10-CM Codes that DO NOT Support Medical Necessity Expand All | Collapse All Group 1

What are the different types of epidural steroid injections?

The ESI can be performed in three ways. Interlaminar (IESI) approaches the epidural space from the posterior spine between the two vertebral laminae near the midline. In the transforaminal approach (TFESI), the injectant is delivered through the neuroforamen dorsal to the nerve root within the intervertebral foramen.

How do you code epidural steroid injection?

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.

Does CPT code 64483 include fluoroscopy?

Fluoroscopic guidance is included in the descriptor of CPT 64483 (Injection(s), anesthetic agent and/or steroid, transforaminal epidural, with imaging guidance (fluoroscopy or CT); lumbar or sacral, single level) and cannot be submitted for separate payment.

What is a transforaminal epidural steroid injection?

A transforaminal lumbar epidural steroid injection (TFESI) is an injection of corticosteroids (anti-inflammatory medication) into the epidural space. When it is done from the side where the nerve exits the spine, it is called a transforaminal injection. It puts medication near the source of the inflammation.

What is the CPT code for caudal epidural steroid injection?

62311. lumbar or caudal epidural injections are for patients with pain in the legs and/or lower back/buttock(s) area. 62318.

What is the CPT code for fluoroscopy?

8. Fluoroscopy reported as CPT code 76000 is integral to many procedures including, but not limited, to most spinal, endoscopic, and injection procedures and shall not be reported separately. For some of these procedures, there are separate fluoroscopic guidance codes which may be reported separately.

Does CPT code 27096 include fluoroscopy?

CPT code 27096 is defined as including fluoroscopic or CT guidance, but not ultrasound (Injection procedure for sacroiliac joint, anesthetic/steroid, with image guidance (fluoroscopy or CT) including arthrography when performed).

What is the difference between an epidural and a transforaminal epidural?

The idea is that epidurals can provide these benefits without surgical interference, reducing the risk. A transforaminal epidural is an epidural injected into a specific part of the body. With a transforaminal epidural injection, your doctor inserts a small-gauge blunt needle into your epidural area.

What does transforaminal approach mean?

In theory, the transforaminal approach allows the injection needle to reach the closest possible position to either the distal nerve root or the anterior portion of the epidural space.

What does Transforaminal mean?

Transforaminal = through the foramina, openings through which nerve roots exit the spine. Interbody = between the vertebral bodies. Lumbar = having to do with the spine in the lower back. Fusion = a process in which bones “fuse,” or grow together into one bone.

What is the ICD 10 code for steroid injection?

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.

What is the CPT code for intrathecal injection?

62361 (Implantation or replacement of device for intrathecal or epidural drug infusion; nonprogrammable pump).

What is lumbar epidural injection?

A lumbar epidural steroid injection (lumbar ESI) is an injection of anti-inflammatory medicine — a steroid or corticosteroid — into the epidural space around the spinal nerves in your low back.

What modifier is used for non-covered services?

Effective from April 1, 2010, non-covered services should be billed with modifier –GA, -GX, -GY, or –GZ, as appropriate.

When to use modifier GX?

Modifier GX (“Notice of Liability Issued, Voluntary Under Payer Policy”) should be used when the beneficiary has signed an ABN, and a denial is anticipated based on provisions other than medical necessity, such as statutory exclusions of coverage or technical issues. An ABN is not required for these denials, but if non-covered services are reported with modifier GX, will automatically be denied services.

When to use G89.3?

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.

Can you use CPT in Medicare?

You, your employees and agents are authorized to use CPT only as contained in the following authorized materials of CMS internally within your organization within the United States for the sole use by yourself, employees and agents. Use is limited to use in Medicare, Medicaid or other programs administered by the Centers for Medicare and Medicaid Services (CMS). You agree to take all necessary steps to insure that your employees and agents abide by the terms of this agreement.

General Information

CPT codes, descriptions and other data only are copyright 2020 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.

CMS National Coverage Policy

When the documentation does not meet the criteria for the service rendered, or the documentation does not establish the medical necessity for the services, such services will be denied as not reasonable and necessary under Section 1862 (a) (1) of the Social Security Act.

Article Guidance

The following coding and billing guidance shall be used with its associated Local Coverage Determination.

Bill Type Codes

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.

Revenue Codes

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.

General Information

CPT codes, descriptions and other data only are copyright 2020 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.

CMS National Coverage Policy

When the documentation does not meet the criteria for the service rendered, or the documentation does not establish the medical necessity for the services, such services will be denied as not reasonable and necessary under Section 1862 (a) (1) of the Social Security Act.

Article Guidance

The billing and coding information in this article is dependent on the coverage indications, limitations and/or medical necessity described in the related LCD.

Bill Type Codes

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.

Revenue Codes

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.

Is CPT code subject to CCI?

The HCPCS/CPT code (s) may be subject to Correct Coding Initiative (CCI) edits in addition to guidance in this L CD. Please refer to the CCI for correct coding guidelines and specific applicable code combinations prior to billing Medicare. Whichever guidance is more restrictive should be adhered to.

Can you use CPT in Medicare?

You, your employees and agents are authorized to use CPT only as contained in the following authorized materials of CMS internally within your organization within the United States for the sole use by yourself, employees and agents. Use is limited to use in Medicare, Medicaid or other programs administered by the Centers for Medicare and Medicaid Services (CMS). You agree to take all necessary steps to insure that your employees and agents abide by the terms of this agreement.

Is CESI a good option for cervicogenic headache?

The CESI is considered by many interventional pain management specialists to be a reasonable option for patients who have failed conservative treatments for cervicogenic headache. A 2014 review on CESI for cervicogenic headache found no RCTs, and two prospective studies, with thirty-six patients in the studies combined), that support a role of CESI for this indication; however, there is a paucity of literature to support this indication. 18

Is epidural injection safe?

Epidural administration of corticosteroids has not been approved by the FDA and is classified as “off-label” use. While complications with ESIs are rare, they can be devastating. In 2014, the FDA issued a drug safety communication about the epidural injection of glucocorticoids, noting the potential for rare but serious adverse effects, and the effectiveness has not been established. 31 The warning followed two separate outbreaks of fungal meningitis 2002 and 2012-2013 linked to ESIs and multitudes of case reports on related complications. After the FDA warning, there was a flurry of papers to document safety and provide protocols and /or guidelines to improve safety. The reported risk of ESIs includes loss of vision, stroke, dural puncture, infection, spinal cord injury, paralysis, and death. In addition to intra-arterial injections of particulate steroids, arachnoiditis, nerve damage, osteomyelitis, hemorrhage, and epidural abscess have been reported. 1,32 In a 2015 review on trends in safety and complications, the author explains the reasons for these risks stating “significant neurological complications associated with transforaminal injections include stroke and spinal cord injury, which arise due to the need to place the needle within the intervertebral foramina. This space contains radicular arteries that perfuse the spinal cord and course adjacent to the targeted spinal nerve root, creating a challenge when variations in anatomical structure are present”. 1 A 2018 survey of 249 interventional pain management physicians (13.8% response rate) demonstrated a high level of variability and lack of standardized practices. They reported that in interlaminar epidural steroid injection practice patterns, there is a lack of standardization in needle sizes, use of imaging, and choice of injectant. 33 The lack of evidence-based standardized practice makes it difficult to interpret the literature since these variables exist across existing studies.

Can ESI be used for lumbar stenosis?

The evidence surrounding the use of ESIs for lumbosacral spinal stenosis is conflicting. A 2014 double-blind, multisite, randomized controlled trial funded by the Agency for Healthcare Research and Quality reported on 400 patients with lumbar central spinal stenosis with moderate to severe pain (>4/10 at baseline) and a disability score of 7 or higher on the RMDQ to receive ESI with glucocorticoids plus lidocaine or lidocaine alone. The patients received one or two injections and evaluation at six weeks from the first injection. At six weeks, there was no significant difference between the groups RMDQ scores (adjusted difference in the average treatment effect between the glucocorticoid–lidocaine group and the lidocaine-alone group, -1.0 points; 95% confidence interval [CI], -2.1 to 0.1; P = 0.07) or leg pain scores (adjusted difference in the average treatment effect, -0.2 points; 95% CI, -0.8 to 0.4; P = 0.48). They concluded ESI with LA and glucocorticoids offered minimal or no short-term benefit compared to ESI with LA alone. 59 This was met by support for surgical management or trial of conservative measures for lumbar spinal stenosis and criticism from members of the interventional pain management community. 60 A 2015 systematic review and meta-analysis, including eight trials on ESIs for spinal stenosis, concludes there were no clear effects of ESIs for spinal stenosis with the strength of evidence rated low to moderate. 52 The 2019 MIST Guidelines for lumbar spinal stenosis from the minimally invasive spine treatment consensus group evaluated nine studies (2 randomized controlled trials [RCTs]; 7 observational studies, four prospective studies and three retrospective studies) of minimally invasive spine treatments and reported there is Level I evidence for percutaneous image-guided lumbar decompression as superior to lumbar ESIs. The consensus group developed treatment algorithms to guide management. 61

Is ESI good for spinal stenosis?

Of these patients, thirty-two precent opted for surgery, 24% had repeat injections, and 44% were satisfied with non-surgical management at two years. The authors conclude TFESI is a reasonable treatment for lumbar spinal stenosis, provides long-term relief in a high proportion of patients, and can reduce the need for surgical management. 62 There are prospective studies supporting this use. 63 A 2015, double-blinded RCT compared the effectiveness of lumbar ILESI with LA only to lumbar ILESI with corticosteroids and LA with central spinal stenosis. Assessments to measure success were defined as = 50% pain relief at 3,6,12, 18, and 24 months. They reported 72% (95% CI: 61-83%) of patients receiving lidocaine and corticosteroids and 73% (95% CI: 62-85%) receiving lidocaine alone had significant pain relief at 24 months; concluding ESI with LA with or without steroids were equally effective and beneficial. 64 However, overlapping confidence intervals suggest the treatments are equivalent at those timeframes, so it does not provide evidence for long-term improvement. In the 2015 systematic review of 52 RCTs with placebo control or active-control design looking at the efficacy of EPIDURAL injections in managing chronic spinal pain, they concluded Level II evidence for caudal and lumbar interlaminar EPIDURAL injections with Level III evidence for lumbar transforaminal epidural injections for lumbar spinal stenosis. The evidence is Level II for cervical spinal stenosis management with an interlaminar approach. 54