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Pain Management Coding Alert

Reader Question:

Make Sure ESI Code Includes Proper Guidance

Question: What is the correct way to report a caudal epidural steroid injection (ESI) under ultrasound guidance? I’m considering 62322, 76942, and 62323, but am not sure how they’re classified by coding edits. And does the “with imaging guidance” in the descriptor for 62323 include ultrasound?

Connecticut Subscriber

Answer: File the claim with 62322 (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); without imaging guidance) and 76942 (Ultrasonic guidance for needle placement (eg, biopsy, aspiration, injection, localization device), imaging supervision and interpretation).

Code 62323 (… with imaging guidance (ie, fluoroscopy or CT)) represents the same injection with imaging guidance, but does not fit in this case because the provider used ultrasound guidance instead of fluoroscopy or CT.

Take note: Current National Correct Coding Initiative (NCCI, or CCI) edits list 76942 as a Column 2 code of an edit pair with 62322. You can break the edit with a modifier and report both codes, but need thorough documentation of service to show why both codes are justified (instead of only 62322).