For epidural infusion, the patient is placed in sitting or lateral decubitus position. The physician inserts a catheter into the vertebral interspace of the cervical or thoracic region for continuous or intermittent infusion of material. The physician provide continuous infusion or intermittent bolus injection of solution to provide a therapeutic or diagnostic outcome. The solution is injected into the interlaminar epidural or subarachnoid space.When the procedure is complete, the catheter is removed.

Use CPT code 62324 when the procedure is performed on interlaminar epidural or subarachnoid, cervical or thoracic region without imaging guidance and 62325 when imaging guidance is utilized.

Similarly when the exam is performed on interlaminar epidural or subarachnoid, lumbar or sacral region, assign CPT code 62326 without guidance and when guidance is used report CPT code 62327.

The imaging guidance will be either fluoroscopy or CT, use CPT code 77003 for fluoroscopic guidance and 77012 for CT guidance.

Clinical Indication

Pain

labor

Foraminal stenosis

Lateral recess stenosis

Disc protrusions,

Herniations and

Neoplasms.

Table of Contents

Description of CPT code 62324, 62325, 62326 and 62327

The epidural injection code choice is based on the region at which the needle or catheter enters the body. The code should be reported only once when the injected substance spreads or the catheter tip insertion moves into another spinal region.

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

62325 – ; with imaging guidance (ie, fluoroscopy or CT)

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

62327 – ; with imaging guidance (ie, fluoroscopy or CT)

Catheter Implantation CPT code 62350, 62351 and 62355

There are separation CPT codes for implantation of intrathecal or epidural catheter for long term medication administration. An intrathecal catheter is a tube that is inserted into the spinal fluid and the other end is buried under the skin and comes out to allow drugs to be given through the catheter. Drugs are slowly and continuously given from a small pump attached to the catheter.

CPT Code 62350, 62351 are used for implantation and 62355 is used for removal of intrathecal or epidural catheter.

62350 – Implantation, revision or repositioning of tunneled intrathecal or epidural catheter, for long-term medication administration via an external pump or implantable reservoir/infusion pump; without laminectomy

62351 – ; with laminectomy

62355 – Removal of previously implanted intrathecal or epidural catheter

When to use CPT code 62360, 62361, 62362 & 62365

Also, there are procedures for Reservoir or pump implantation or replacement. An intrathecal pump is a medical device used to deliver medications( e.g. chemotherapy, pain management drugs) directly into the space between the spinal cord and the protective sheath surrounding the spinal cord. The reservoir is placed in the subcutaneous tissues and attached to a previously placed catheter. Layered sutures are used to close the incision. CPT code 62360 is used for non-programmable pump implantation or replacement, 62362 for a programmable pump implantation or replacement and 62365 for removal of the reservoir or pump.

62360 – Implantation or replacement of device for intrathecal or epidural drug infusion; subcutaneous reservoir

62361 – Implantation or replacement of device for intrathecal or epidural drug infusion; nonprogrammable pump

62362 – Implantation or replacement of device for intrathecal or epidural drug infusion; programmable pump, including preparation of pump, with or without programming

62365 – Removal of subcutaneous reservoir or pump, previously implanted for intrathecal or epidural infusion

Electronic analysis CPT code 62367, 62368, 62369, 62370

Few procedure codes are for the electronic analysis to check the performance of the generator, placed by nurse or physician over the site of a programmable pump. Use CPT code 62367 if the pump is not reprogrammed or refilled and 62368 if it is reprogrammed. Use CPT code 62369 if it is reprogrammed and refilled and 62370 if it is reprogrammed refilled and requires a physician or other qualified health care professional’s intervention.

62367 – Electronic analysis of programmable, implanted pump for intrathecal or epidural drug infusion (includes evaluation of reservoir status, alarm status, drug prescription status); without reprogramming or refill

62368 – ; with reprogramming

62369 – ; with reprogramming and refill

62370 – ; with reprogramming and refill (requiring skill of a physician or other qualified health care professional)

Also there are separate CPT code for Refilling and maintenance of the implantable spinal (intrathecal, epidural) or intraventricular (brain) pump or reservoir. This procedure codes includes the electronic analysis of pump. In this exam, Implantable pumps or reservoirs are placed in subcutaneous pockets at appropriate sites on the body and a long-term supply of the drug or medication being infused into the patient. They are refilled through the skin by a needle placed into the pump device. The pump is refilled through the skin by a needle placed into the pump device.

The pump may have electronic analysis performed, including evaluation of reservoir status, alarm status, and drug prescription status. Use CPT code 95991 when a physician or other qualified health care provider’s skill is required to perform the refill and/or maintenance.

95990 – Refilling and maintenance of implantable pump or reservoir for drug delivery, spinal (intrathecal, epidural) or brain (intraventricular), includes electronic analysis of pump, when performed;

Code 95990 has no physician work value and describes the services reported by a nonphysician provider.

It is important to note that E/M services are not included in codes 95990 and 95991. If a significant separately identifiable E/M service is performed, the appropriate E/M service code should be reported using modifier 25 in addition to code 99590 and 95991.

95991 – Refilling and maintenance of implantable pump or reservoir for drug delivery, spinal (intrathecal, epidural) or brain (intraventricular), includes electronic analysis of pump, when performed; requiring skill of a physician or other qualified health care professional

Do not report 99590-99591 in conjunction with 62327-62370.

77003 – Fluoroscopic guidance and localization of needle or catheter tip for spine or paraspinous diagnostic or therapeutic injection procedures (epidural or subarachnoid) (List separately in addition to code for primary procedure)