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Orthopedic Coding Alert

Reader Question:

Two Levels of Epidural

Question: Can we bill 62311 (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 subarachnoid; lumbar, sacral [caudal]) twice if the orthopedist injects two different levels? Anonymous Subscriber Answer: Most payers will deny two units of 62311 when billed on the same day. California's Part B carrier states, "Payment will be made for up to three injections in any given six (6) month period. If additional injections within this time frame are deemed medically reasonable, documentation supporting the necessity must accompany the claim."

South Carolina's Part B carrier limits patients to six epidural injections per year, after which hard-copy documentation is required. Some practices report success when listing 62311 on separate line items with modifier -59 (Distinct procedural service) appended to the second injection code and with hard-copy documentation attached to the claim to document medical necessity of separate site injections. Your best bet is to contact your payer ahead of time to determine whether this is allowable. The January 2000 CPT Assistant advises, "CPT codes 62310-62319 are unilateral procedures. These codes are reported once per level, per side, regardless of the number or type of injections performed per level, per side. Therefore, it is inappropriate to report the spinal injection code(s) for each injection performed at a particular level and side. However, if both sides of the same spinal level are injected, then modifier -50 (Bilateral procedure) should be appended to the specific injection procedure code to indicate that bilateral procedures were performed. If injections are performed at different spinal levels (e.g., C2 and C4), then the spinal injection codes are reported for each level of the spinal region involved."

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