Four familiar epidural injection codes have been removed from the 2017 CPT* code set to reflect a change implemented in the final rule of the 2017 Medicare Physician Fee Schedule. Codes 62310, 62311, 62318, and 62319 have been removed, and in their place, eight new codes to reflect whether the injection was done with or without imaging guidance.
The new codes are listed below:
| CODE | DESCRIPTION |
| 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 |
| 62321 | with imaging guidance (i.e., fluoroscopy or CT) |
| 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 |
| 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) (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 (i.e., 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 (i.e., fluoroscopy or CT) |
According to the American Academy of Pain Medicine, several professional medical associations, including the American Society of Anesthesiologists (ASA) and the AAPM, began working with CMS to address concerns about potentially misvalued codes back in 2012.
According to the ASA, CMS initially attempted to re-value codes 62310-62311 and 62318-62319 through drastic reductions of the wRVUs for 2014. The cohort of specialties appealed to CMS to revert back to the original work values for 2015, and while CMS agreed, they would no longer allow separate reporting of any associated imaging, such as code 77003 for fluoroscopic guidance.
Under the new coding scheme, physicians still are not allowed to report codes 77003, 77012, 76942 or any other guidance codes in addition to epidural injections. However, they can choose from codes 62321, 62323, 62325, and 62327 that include the imaging as reflected in the increased wRVUS.
What does this mean for code selection?
| If you would have chosen … | Now Choose This with Imaging … | Now Choose This without Imaging … |
| 62310 – Cervical and Thoracic Single Shot | 62321 | 62320 |
| 62311 – Lumbar Single Shot | 62323 | 62322 |
| 62318 – Cervical and Thoracic Catheter | 62325 | 62324 |
| 62319 – Lumbar Catheter | 62327 | 62326 |
What does this mean for your bottom line? Here’s a glimpse at the wRVUs for the new and old coding schemes side by side(assuming an imaging code would have been added when necessary per the pre-2015 guidelines).
| Old Code | Old wRVUs | New Codes | New wRVUs |
| 62310 | 1.91 | 62320 | 1.80 |
| 62311 | 1.54 | 62322 | 1.55 |
| 62318 | 2.04 | 62324 | 1.89 |
| 62319 | 1.89 | 62326 | 1.78 |
| 62310 + 77003 | 1.91 + .38 = 2.29 | 62321 | 1.95 |
| 62311 + 77003 | 1.54 + .38 = 1.92 | 62323 | 1.80 |
| 62318 + 77003 | 2.04 + .38 = 2.42 | 62325 | 2.20 |
| 62319 + 77003 | 1.89 + .38 = 2.27 | 62327 | 1.90 |
For more information about how these changes affect your practice, contact CIPROMS today.
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