Epidural Steroid Injection (ESI) Codes

This installment of “In the kNOW” focuses 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,
            and
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.

CPT Code Changes for 2017

This “In the kNOW” topic addresses a major change in CPT coding for 2017 regarding moderate (conscious) sedation.  This type of sedation allows a patient to purposefully respond when given verbal commands after being medicated.  It is not necessary to provide airway or cardiovascular support, and the patient’s own breathing is sufficient.  In the past, moderate sedation was considered part of select CPT codes and identified by the presence of an encircled bullet symbol, like this:

Effective January 1, 2017, there is a new way to code for moderate sedation thus resulting in revisions to many codes.  
 

A review of Appendix B indicates a large number of codes impacted by this change which is also reflected by review of Appendix G which has been removed from CPT.  Review of the explanatory note found under Appendix G provides coders with the information that the moderate sedation symbol, has been removed from the codes it was previously associated with and that is confirmed in Appendix B, where we see the codes preceded by the moderate sedation symbol with a strikethrough, like this: 

Appendix G now refers coders to new CPT codes 99151-99157 in order to capture moderate sedation, and Appendix B indicates that codes 99143-99150 which applied to procedures where it was appropriate to code moderate sedation separately have been deleted.  These new moderate sedation codes are inclusive of preservice, intraservice, and postservice work.  However, the code selection is solely based on the intraservice time as the pre and post work are included in the codes.  Components of the intraservice time include:

• Starts with administration of sedation
• Ends with completion of procedure, determination that patient is stable, and provider face-to-face time concludes
• Initial and subsequent orders and administration of sedation are included
• Continuous face-to-face time by provider is required
• Patient is monitored for sedation response

The new section of moderate sedation codes (99151-99157) are based on 15 minute increments of time as well as the age of the patient, and whether or not the sedation is provided by the same individual who is performing the diagnostic or therapeutic service.  For example, code 99151 is for the first 15 minutes of conscious sedation on a patient who is younger than 5 years old by the same provider performing the diagnostic or therapeutic service.  Add-on codes 99153 and 99157 are for each additional 15 minutes of intraservice time regardless of age.    

Further information on this important change in CPT can be found in the 2017 CPT Manual under Appendices B and G, and in the notes preceding the new CPT codes 99151-99157.  

Now you are In the kNOW!!

If you are interested in learning more about the CPT code updates coming in 2017, register for our webinar on this topic!  

Dianna Foley, the author of this article, will be the presenter on the webinar.  

 See our website for registration and details.

 
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.