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Basics of CPT code 62320, 62322, 62323, 62324 & 62326

Before going to learn about the spinal codes, we will learn about few exams in diagnostic radiology. There are injection procedures like arthrocentesis, arthrogram, ,myelogram etc which required guidance codes. Their are also biopsy and Incision & drainage codes used to code frequently by medical coders. Once, you get perfect in coding surgery procedure, you will surely improve you coding skills in coding.

However, you may be interested in other posts in the series:

When to use CPT code 36901 for AV fistula Access

Superb guide for Certified Coding Specialist or CCS exam

Selective and Non-Selective Catheterization Coding Rules

ICD 10 coding tips for Subsequent encounter in fracture coding

Learn when to use Z codes in ICD 10

Use of CPT code 62320 and 62321

The CPT code 62320, is used in place of CPT code 62310 (deleted). Also, we have another CPT code 62321 for procedures which are done with guidance like CT (Computed tomography) or Fluoroscopy. The guidance code 77003 or 77012 are remain included in the procedure codes, but we have a separate CPT code 62320 for without guidance exam.

Description of pain management CPT code 62320 and 62321

CPT code 62320 – (Injection[s], of diagnostic or therapeutic substance[s] [eg, 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).

CPT code 62321 – ; with imaging guidance (ie, fluoroscopy or CT)

The coding of these pain management procedures has become easy. Now, the codes also include the guidance codes. Similar changes happened with breast biopsy earlier where they included guidance coded with the breast biopsy codes. These kind of codes reduces the stress of medical coders.

When to use CPT code 62322 and 62323

Here, also we have to follow the same procedure. CPT code 62322 and 62323 are coded depending on the epidural injection and with or without guidance like Fluoroscopy and CT.

Description of epidural injection CPT code 62322 and 62323

CPT code 62322 (Injection[s], of diagnostic or therapeutic substance[s] [eg, 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).

CPT code 62323 – ; with imaging guidance (ie, fluoroscopy or CT)

It is very important now to remain updated with the new procedure codes. If you are preparing for medical coding certification exam like CPC, you have to know the coding guidelines for each and every code. Clearing CPC exam in first attempt (out of two attempts) needs lot of hard and smart work.

For CCS exam medical coders have only one attempt, hence their is no chance in this to do any mistake. If you fail in first attempt in CPC, you have one more FREE attempt to clear the exam, but if for CCS exam you have first or last attempt only to clear the exam. Try to prepare by solving model CPC or CCS exam paper to know the paper pattern and manage the time.

When to use CPT code 62324 and 62325

You have to again look for the use of guidance like fluoroscopy and CT, to choose the appropriate code.

CPT code 62324 (Injection[s], including indwelling catheter placement, continuous infusion or intermittent bolus, of diagnostic or therapeutic substance[s] [eg, anesthetic, antispasmodic, opioid, steroid, other solution], not including neurolytic substances, interlaminar epidural or subarachnoid, cervical or thoracic; without imaging guidance).

CPT code 62325 – Injection(s), of diagnostic or therapeutic substance(s) (eg, anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, including needle or catheter placement, interlaminar epidural or subarachnoid, lumbar or sacral (caudal); with imaging guidance (ie, fluoroscopy or CT)

When to use CPT code 62326 and 62327

We have two CPT codes 62326 and 62327 to replace the old code 62319 (deleted). Do check the presence of imaging guidance like fluoroscopy and CT, before coding the CPT code 62326 and 62327 for this exam.

CPT code 62326 (Injection[s], including indwelling catheter placement, continuous infusion or intermittent bolus, of diagnostic or therapeutic substance[s] [eg, anesthetic, antispasmodic, opioid, steroid, other solution], not including neurolytic substances, interlaminar epidural or subarachnoid, lumbar or sacral [caudal]; without imaging guidance).

CPT code 62327 – Injection(s), including indwelling catheter placement, continuous infusion or intermittent bolus, of diagnostic or therapeutic substance(s) (eg, anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, interlaminar epidural or subarachnoid, lumbar or sacral (caudal); with imaging guidance (ie, fluoroscopy or CT)

When to use CPT code 62380

There is one more CPT code for decompression procedure of spines. Hence do use the CPT code 62380 in place of the old CPT code 62287 (deleted).

62380 – Endoscopic decompression of spinal cord, nerve root(s), including laminotomy, partial facetectomy, foraminotomy, discectomy and/or excision of herniated intervertebral disc, 1 interspace, lumbar

Other related CPT codes for pain management in Surgery

Facet joint injection procedures

64490 Intraarticular joint or medial branch block (MBB) – cervical or thoracic (1st level)

64491 Intraarticular joint or medial branch block (MBB) – cervical or thoracic (2nd level)

64492 Intraarticular joint or medial branch block (MBB) – cervical or thoracic (3rd level)

64493 Intraarticular joint or medial branch block (MBB) – lumbar or sacral (1st level)

64494 Intraarticular joint or medial branch block (MBB) – lumbar or sacral (2nd level)

64495 Intraarticular joint or medial branch block (MBB) – lumbar or sacral (3rd level)

Transforaminal injections Procedures

• 64479, single-level injection cervical/thoracic region;

• 64480, each additional level cervical/thoracic region;

• 64483, single-level injection lumbar/sacral region; and

• 64484, each additional level lumbar/sacral region.

Destruction by Neurolytic Agent (Radiofrequency (RF) ablation procedures)

64626, single level of cervical /thoracic region;

64627, each additional level of cervical /thoracic region;

64622, single level of lumbar/sacral region; and

64623, each additional level of lumbar/sacral region

Description of CPT code 62320, 62322, 62323, 62324 & 62326

The skin over the spinal region to be injected is cleansed with an antiseptic solution and a local anesthetic is injected. A thin spinal needle or catheter is inserted into the back of the epidural or subarachnoid space through a paramedian or midline interlaminar approach, usually under fluoroscopic guidance. The epidural space is the outermost area of the spinal canal filled with cerebrospinal fluid that lies between the outermost protective membrane (dura mater) surrounding the nerve roots and the vertebral wall.

The subarachnoid space lies closer to the spinal cord and is located between the middle protective membrane, the arachnoid, and the innermost delicate membrane surrounding the spinal cord, the pia mater. Contrast dye may be injected first to confirm proper needle placement, to perform an epidurography, and to see that the medication is traveling into the desired area. A diagnostic or therapeutic substance, such as an anesthetic, antispasmodic, opioid, steroid, or other solution, such as a steroid and local anesthetic mix, excluding a neurolytic substance, is injected into the epidural or subarachnoid space.

Following injection, the patient is monitored for any adverse effects. CPT code 62320 is reported for interlaminar epidural or subarachnoid injection(s) in the cervical or thoracic region without imaging guidance and CPT code 62322 for the lumbar or sacral (caudal) region. CPT code 62321 is reported for similar injection(s) done with imaging guidance, such as fluoroscopy or computed tomography (CT), in the cervical or thoracic region and CPT code 62323 is reported for the lumbar or sacral (caudal) region.

The placement and use of a catheter to administer one or more epidural or subarachnoid injections on a single calendar day should be reported in the same manner as if a needle had been used, ie, as a single injection using either 62320, 62321, 62322, or 62323. Such injections should not be reported with 62324, 62325, 62326, or 62327.

Threading a catheter into the epidural space, injecting substances at one or more levels and then removing the catheter should be treated as a single injection (62320, 62321, 62322, 62323). If the catheter is left in place to deliver substance(s) over a prolonged period (ie, more than a single calendar day) either continuously or via intermittent bolus, use 62324, 62325, 62326, 62327 as appropriate.

When reporting 62320, 62321, 62322, 62323, 62324, 62325, 62326, 62327 code choice is based on the region at which the needle or catheter entered the body (eg, lumbar). Codes 62320, 62321, 62322, 62323, 62324, 62325, 62326, 62327 should be reported only once, when the substance injected spreads or catheter tip insertion moves into another spinal region (eg, 62322 is reported only once for injection or catheter insertion at L3-4 with spread of the substance or placement of the catheter tip to the thoracic region).

Percutaneous spinal procedures are done with indirect visualization (eg, image guidance) (eg, 62287). Endoscopic assistance during an open procedure with continuous and direct visualization (light-based) is reported using excision codes (eg, 63020-63035).