Pain Management: Levels Outweigh Frequency When Coding Interlaminar Epidural Injections

By Author: Angela Martin
Total Articles: 206
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Pain management specialists and neurologists often carry out interlaminar epidural injections. The next time you are faced with one of these claims, see to it to mark the differences between interlaminar epidurals and other common spinal injections.

Give the bilateral modifier a miss

If your interventional doctor carries out more than one interlaminar epidural injection in the same spinal region, you do not append modifiers automatically.

Here's the reason: When your provider injects a substance into the epidural space through an interlaminar approach, the drug diffuses into the entire area. The spreading does away the need to inject medication into both sides of the space to get the desired results. As such, you will not need to include modifier 50 on your claim to document that the provider treated the complete space.

Watch levels, not injections

By the same token, multiple attempts to reach the same epidural space doesn't equal multiple procedures. You will learn this thanks to the procedure descriptor for interlaminar ...
... epidural injections.

Remember separate fluro is ok

Most doctors use fluoroscopic guidance to pinpoint the injection site and ensure they inject medication into the correct location. If your doctor uses fluroscopy, add 77003 to your claim.

Confusion: Some insurance companies deny 77003 with 62311, stating the procedure includes fluoroscopic guidance. The description clearly doesn't include fluoroscopic guidance; however does include the doctor work of the actual injection of contrast during fluoroscopic guidance and localization. I think that is where the confusion comes from.

For more on this and other pain management coding tips, sign up for an audio conference. An audio conference will also provide you a thorough understanding of all the coding changes in store for the coming year. But the best part of attending such a pain management conference is the CEUs that you stand to gain to keep your certification current.