Location, Location, Location! Reimbursement for Epidural Blocks Depends on Establishing Medical Necessity and Area
Epidural blocks provide effective pain management for patients with spine-related injuries or illnesses. But reporting these procedures and collecting payment can be difficult. Codes must be selected according to the spinal area injected, and medical necessity must be established through the use of approved diagnoses. Also, multiple injections and/or additional services may be provided at the same time as an epidural block but are not always separately billable.
Epidural blocks are administered to reduce pain and inflammation or to confirm a diagnosis. Initially, a local anesthetic is given. A needle is introduced to the epidural space, through which an anesthetic, steroid, antispasmodic and/or neurolytic agent is injected. These injections are commonly used to treat nonsurgical spinal conditions (e.g., sciatica), but are also effective in managing postsurgical pain or non-spine-related afflictions.
The procedures are reported using four code groups (62280-62282, 62310-62311, 62318-62319 and 64479-64484), depending on the agent and method of injection. Within each group, individual codes are differentiated according to the targeted spinal area cervical, thoracic, lumbar or sacral.
The first epidural block code group is used to report the injection of neurolytic substances, agents that destroy nerves:
62280 injection/infusion of neurolytic substance (e.g., alcohol, phenol, iced saline solutions), with or without other therapeutic substance; subarachnoid
62281 epidural, cervical or thoracic
62282 epidural, lumbar, sacral (caudal).
These injections are given to destroy damaged nerves that are the source of a patient's pain or to affect adhesions following surgery, says Catherine Brink, CMM, CPC, president of Healthcare Resource Management Inc., a physician practice management consulting firm in Spring Lake, N.J.
Report 62280 for injections to subarachnoid space, regardless of the spinal level. This is the area beneath the arachnoid membrane (the middle of the three coverings surrounding the central nervous system), which lies below the dural layer. Epidural injections, which are closer to the skin, are differentiated by spinal level. Because of these distinctions, coders working from physician notes must encourage neurologists to document the depth and location of injections, Brink says.
The second and third code groups describe trans-laminar (either epidural or subarachnoid) epidurals, says Francis Lagattuta, MD, chairman of the CPT nonoperative coding committee for the North American Spine Society and a board member of the American Association of Electrodiagnostic Medicine. The first of these groups describes a single injection of substances other than neurolytic agents:
62310 injection, single (not via indwelling catheter), not including neurolytic substances, with or without contrast (for either localization or epidurography), of diagnostic or therapeutic substance(s) (including anesthetic, antispasmodic, opioid, steroid, other solution), epidural or [...]
Want more code info & how to
articles for Neurology & Pain Management Codes?
Sign-up for Neurology & Pain Management Coder's FREE Trial Today to:
- Simplify neurology & pain management code lookup across CPT®, ICD-9, ICD-10, & HCPCS codes
- Get fee schedules rates, global days, MUEs all at one place
- Meet the code’s requirements with easy-to-understand tips
- Check allowed modifiers
- Cut CCI edits checking time by 94%