2017 brought a new version of Correct Coding Initiative (CCI) edits, with thousands of changes, many of which affect your anesthesia coding.
CCI edits bundle virtually every anesthesia CPT® code into a group of thirteen procedures. Eight of these represent the newly established codes for epidural administration:
- 62320 — Injection(s), of diagnostic or therapeutic substance(s) (e.g., anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, including needle or catheter placement, interlaminar epidural or subarachnoid, cervical or thoracic; without imaging guidance
- 62321 — … with imaging guidance (i.e., fluoroscopy or CT)
- 62322 — Injection(s), of diagnostic or therapeutic substance(s) (e.g., 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
- 62323 — … with imaging guidance (i.e., fluoroscopy or CT)
- 62324 — Injection(s), including indwelling catheter placement, continuous infusion or intermittent bolus, of diagnostic or therapeutic substance(s) (e.g., anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, interlaminar epidural or subarachnoid, cervical or thoracic; without imaging guidance
- 62325 — … with imaging guidance (i.e., fluoroscopy or CT)
- 62326 — Injection(s), including indwelling catheter placement, continuous infusion or intermittent bolus, of diagnostic or therapeutic substance(s) (e.g., anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, interlaminar epidural or subarachnoid, lumbar or sacral (caudal); without imaging guidance
- 62327 — … with imaging guidance (i.e., fluoroscopy or CT)
“It could be hard to get used to the new epidural codes because we’ve had the other ones for so many years,” says Kelly D. Dennis, MBA, ACS-AN, CANPC, CHCA, CPC, CPC-I, owner of Perfect Office Solutions in Leesburg, Fla. “And, as I understand it, ‘image guidance’ includes ultrasound even though it is not listed in the ‘i.e.’”
The similarities: The new codes are differentiated by anatomic site (cervical/thoracic and lumbar/sacral). They also continue to represent either a single epidural injection or an indwelling catheter placement.
The differences: The word “interlaminar” has been added to describe the epidural’s placement as either “interlaminar epidural or subarachnoid.” One important deletion is what led to the expansion of choices: the descriptor no longer includes the phrase “includes contrast for localization when performed.”
Each code now specifies whether the provider used imaging guidance.
Looking forward: Edit pairs involving anesthesia services with epidural codes 62320-62327 as well as with 76970 (Ultrasound study follow-up [specify]) have a modifier indicator of “1.” That means you might sometimes be able to “break” the bundle and report both codes — in special circumstances and with sufficient supporting documentation.
Need Help?
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