Coding transforaminal epidural steroid injection

Certain spinal procedures have been designated a top-up of 32%. The list of more complex spinal procedures and the eligible providers can be seen in the spreadsheet on the link above. The two lists were derived in 2008 to better reward spinal centres performing predominantly complex spinal work for the last year of in 2008/9. The list of Hospitals was derived without clinical input but forgotten on the introduction of HRGv4 in April 2009. The British Association of Spine Surgeons (BASS) has written to the Department of Health regarding the list of eligible providers which has resulted in a promise of closer involvement but with no solution to the issue this year. I think HRGv4 has the granularity to reflect this work and the aim will be to allocate this top-up money towards the more expensive procedures next year but within tariff so that all will benefit.

8. CPT codes 64400-64530 describe injection of anesthetic agent for diagnostic or therapeutic purposes, the codes being distinguished from one another by the named nerve and whether a single or continuous infusion by catheter is utilized. All injections into the nerve including branches described (named) by the code descriptor at a single patient encounter constitute a single unit of service(UOS). For example:
(1) If a physician injects an anesthetic agent into multiple areas around the sciatic nerve at a single patient encounter, only one UOS of CPT code 64445 (injection, anesthetic agent; sciatic nerve, single) may be reported.
(2) If a physician injects the superior medial and lateral branches and inferior medial branches of the left genicular nerve, only one UOS of CPT code 64450 (Injection, anesthetic agent; other peripheral nerve or branch) may be reported regardless of the number of injections needed to block this nerve and its branches.

When reporing facet joint codes, you may not bill separately for the image guidance. Whether using fluoroscopy or computed axial tomography, guidance is required. If ultrasound guidance is used for the above procedures, the CPT® codebook states that you must report the facet joint injection using 0213T-0218T Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with ultrasound guidance… . If no imageing is used, you must report 20552-20553 Injection(s); single or multiple trigger point(s)….

Your fluoroscopic guidance, one of the concerns of course in using the fluoroscopy is that the medication won't reach that target level. And you definitely need to use fluoroscopy for transforaminal. More often, physicians are using it in chronic pain for the translaminar also.  An epidurogram during your initial injection, the first time you inject it in the epidural space may be warranted. Fluoral guidance is bundled into all of these codes. So you want to be careful with that and make sure documentation supports it for error free medical coding and billing.

Coding transforaminal epidural steroid injection

coding transforaminal epidural steroid injection

Your fluoroscopic guidance, one of the concerns of course in using the fluoroscopy is that the medication won't reach that target level. And you definitely need to use fluoroscopy for transforaminal. More often, physicians are using it in chronic pain for the translaminar also.  An epidurogram during your initial injection, the first time you inject it in the epidural space may be warranted. Fluoral guidance is bundled into all of these codes. So you want to be careful with that and make sure documentation supports it for error free medical coding and billing.

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