Wednesday, February 22, 2017

Epidural Steroid Injection (ESI) Codes

This installment of “In the kNOWfocuses on the changes to epidural steroid injection (ESI) codes.  Previous codes that identified ESIs have been deleted (62310, 62311, 62318, and 62319) and have been replaced with new codes ranging from 62320-62327. 

ESIs are a common, minimally invasive, treatment method for addressing pain that is the result of inflammation of spinal nerves.  Causes of the pain can be the herniation of an intervertebral disc, spinal stenosis or spondylolysis.  Two medications work in tandem when an ESI is administered.  The first component is a local anesthetic which will work to provide immediate symptom (pain) relief while the second is a corticosteroid which works to reduce the inflammation over time thus affording longer pain relief.  

Until the 2017 CPT update, ESI coding was based on:

the injection site: cervical/thoracic or lumbar/sacral,
the method of administration: injection or injection with indwelling catheter.   

The new 2017 CPT codes for ESIs now include whether or not the ESI was administered with imaging guidance.
–    62320 injection C or T without Imaging Guidance
–    62321 injection C or T with Imaging Guidance
–    62322 injection L or S without Imaging Guidance
–    62323 injection L or S with Imaging Guidance
–    62324 injection with catheter C or T without Imaging Guidance
–    62325 injection with catheter C or T with Imaging Guidance
–    62326 injection with catheter L or S without Imaging Guidance
–    62327 injection with catheter L or S with Imaging Guidance

As coders begin the process of coding for ESIs now, the first consideration will be to determine where the needle or catheter enters the body.  Coders should note that the threading of the catheter into the epidural space, the injection of one or more levels, and the subsequent catheter removal are all components of a single injection.  The ESI should be considered a single injection even if the administered agent spreads to another level or the catheter tip moves into another region.  

When a catheter is placed for an ESI and is used on a single calendar day, coders should report ONE injection only, even if more than one injection is given.  Catheters that are left in place for more than one day in order to provide a bolus or continuous treatment will be coded to the new codes 62324-62327.

Now you are In the kNOW!!

About the Author 

Dianna Foley, RHIA, CHPS, CCS  is OHIMA's Coding Education Coordinator. Dianna has been an HIM professional for 20 years. She progressed through the ranks of coder, department supervisor, and department director, to her current role as a coding consultant. 

She recently served as the program director for Medical Coding and HIT at Eastern Gateway Community College. Dianna earned her bachelor's degree from the University of Cincinnati subsequently achieving her RHIA, CHPS, and CCS certifications. She is an AHIMA Approved ICD-10-CM/PCS Trainer and a a presenter at regional HIM meetings and the OHIMA Annual Meeting.

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