1. 2017 Pain Management Coding
Amy Turner, RN, BSN, MMHC, CPC

2. Epidural Steroid Injections
Indications for ESI
Radicular Pain (pain down leg or arm)
Post Laminectomy Syndrome
Low Back Pain due to central or lateral disc herniation, degenerative disc disease, facet hypertrophy and foraminal or central spinal canal stenosis
Image Requirements
Plain films to rule out fracture or malignancies
MRI or CT may be appropriate prior to ESI
Epidural Steroid Injections

4. Image: MMG, 2005 eorthopod.com
Mayfield Clinic

5. Lumbar Interlaminar Epidural Steroid Injection
Current CPT 62311
Contrast included
Must be performed with imaging guidance.
Films with needle placement and injectate flow retained
No Bilateral
Fluoroscopy if allowable by payer
Lumbar Interlaminar Epidural Steroid Injection
Image: MMG, 2005 eorthopod.com

6. Proposed replacements
Current
Proposed replacements
62311-Injection(s) of diagnostic or therapeutic substance(s) (including anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, including needle or catheter placement includes contrast for localization when performed, epidural or subarachnoid; lumbar or sacral (caudal)
Work RVU- 1.54
$228.94
623X7- 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
Work RVU- 1.55
$153.37
623X8- Injection(s), of diagnostic or therapeutic substance(s) (e.g., anesthetic, antispasmodic, opioid, steroid, other solution), including needle or catheter placement, interlaminar epidural or subarachnoid, lumbar or sacral (caudal); with imaging guidance (i.e., fluoroscopy or CT)
Work RVU- 1.80
$246.67

7. Lumbar Transforaminal ESI
CPT Injection(s), anesthetic agent and/or steroid, transforaminal epidural, with imaging guidance (fluoroscopy or CT); lumbar or sacral; single level
CPT lumbar or sacral, each additional level (list separately in addition to code for primary procedure)
Bilateral allowed for both primary and additional level
50 modifier
No Global period
64483
2016 $225.36
2017 $ % increase
64484
2016 $90.29
2017 $ % increase
Lumbar Transforaminal ESI

8. Right L2 and L3 Transforaminal ESI 64483 64484
Bilateral L3 Transforaminal ESI
modifier
This is not a 2 level injection
Right L3 Transforaminal and Left L3 Transforaminal ESI
modifier
This is not a 2 level injection
Image- 08/30/16 MMG, 2005 eorthopod.com

9. Cervical Interlaminar Epidural Steroid Injection
Current CPT 62310
No specific LCD for Palmetto.
No Bilateral
Contrast included
Fluoroscopy if allowable by payer
Cervical Interlaminar Epidural Steroid Injection

10. Proposed replacements
Current
Proposed replacements
Injection(s), of diagnostic or therapeutic substances(s) (including anesthetic, antispasmodic, opioid, steroid, other solution) not including neurolytic substances, including needle or catheter placement, includes contrast for localization when performed, epidural or subarachnoid; cervical or thoracic
Work RVU 1.91
$247.93
623x5- 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
Work RVU 1.80
$164.70
623x6- With imaging guidance (i.e. fluoroscopy or CT)
Work RVU 1.95
$251.58

11. Cervical Transforaminal Epidural Steroid Injection
CPT Injection(s), anesthetic agent and/or steroid, transforaminal epidural, with imaging guidance (fluoroscopy or CT); cervical or thoracic; single level
CPT cervical or thoracic; each additional level (list separately in addition to code for primary procedure)
Bilateral allowed for both primary and additional level
50 modifier
No Global period
64479
2016 $242.20
2017 $ %
64480
2016 $116.08
2017 $ %
Cervical Transforaminal Epidural Steroid Injection

12. Cervical Transforaminal Epidural Steroid Injection
Image- 08/30/16 MMG, 2005 eorthopod.com

13. Interlaminar Epidural Steroid Injection at C7-T1
62310
Interlaminar Epidural Steroid Injection at T 12-L1
62310
Transforaminal ESI C 4 and C 5 on right
64479
64480
Transforaminal ESI C 5 Bilaterally
modifier

14. Medical Necessity Per Palmetto LCD Lumbar ESI L35148 (sample only)
B Post herpetic polyneuropathy
M Spinal stenosis, lumbar region
M Intervertebral disc disorders with radiculopathy (thoracolumbar M51.15, lumbar M51.16 or lumbosacral M51.17)
M Radiculopathy, (thoracolumbar M54.15, lumbar M54.16, lumbosacral M54.17, sacral M54.18)
M96.1- Post Laminectomy Syndrome, NOS
Medical Necessity

15. M50.02 Cervical disc disorder with myelopathy, mid-cervical region
Add- M Cervical disc disorder with Myelopathy, mid- cervical region, unspecified level
Add- M Cervical disc disorder at C4-C5 level with myelopathy
Add- M Cervical disc disorder at C5-C6 level with myelopathy
Add- M Cervical disc disorder at C6-C7 level with myelopathy
M Cervical disc disorder with radiculopathy, mid cervical region
Add- M Cervical disc disorder at C 4-C5 with radiculopathy
Add- M Cervical disc disorder at C5-C6 with radiculopathy
Add- M Cervical disc disorder at C6-C7 with radiculopathy
ICD 10 changes for 2017

16. M50.22 Other cervical disc displacement, mid cervical region
Add- M Other cervical disc displacement at C4-C5 level
Add- M Other cervical disc displacement at C5-C6 level
Add- M Other cervical disc displacement at C6-C7 level
M50.32 Other cervical disc degeneration, mid cervical region
Add- M Other cervical disc degeneration at C4-C5 level
Add- M Other cervical disc degeneration at C5-C6 level
Add- M Other cervical disc degeneration at C6-C7 level
M50.82 Other cervical disc disorders, mid cervical region
Add- M Other cervical disc disorders at C4-C5 level
Add- M Other cervical disc disorders at C5-C6 level
Add- M Other cervical disc disorders at C6-C7 level
ICD 10 changes for 2017 (cont)

17. M50.92 Cervical disc disorder, unspecified
Add- M Unspecified cervical disc disorder at C4-C5 level
Add- M Unspecified cervical disc disorder at C5-C6 level
Add- M Unspecified cervical disc disorder at C6-C7 level
Add- N50.81 Testicular Pain
Add N Right testicular pain
Add N Left testicular pain
Add N testicular pain, unspecified
Add- N50.82 Scrotal Pain
F Opioid abuse, uncomplicated
Add description- Opioid use disorder, mild
F11.20 Opioid dependence, uncomplicated
Add description- Opioid use disorder, moderate
Add description- Opioid use disorder, severe
ICD 10 changes for 2017 (cont)

18. Arthrocentesis, aspiration and/or injection, small joint or bursa (eg, finger, toes; without ultrasound guidance
With ultrasound guidance with permanent recording and reporting
CANNOT bill US If using fluoro- use fluoroscopic guidance for needle placement
20604 includes ultrasound guidance. DO NOT use for fluoro guidance
Joint Injections
Image- 08/30/16 MMG, 2004 eorthopod.com

19. Intermediate Joint Injections
Arthrocentesis, aspiration and/or injection, intermediate joint or bursa (e.g., temporomandibular, acromioclavicular, wrist, elbow or ankle, olecranon bursa); without ultrasound guidance.
with ultrasound guidance, with permanent recording and reporting
CANNOT be billed with If fluoroscopy used (fluoroscopic guidance for needle placement (e.g., biopsy, aspiration, injection, localization device)
20606 includes ultrasound guidance. DO NOT use for fluoro guidance
Intermediate Joint Injections
Image- 08/30/16 MMG, 2001 eorthopod.com

20. Arthrocentesis, aspiration and/or injection, major joint or bursa (e.g., shoulder, ship, knee, sub acromial bursa); with ultrasound guidance
with ultrasound guidance, with permanent recording and reporting
DO NOT report with If fluoro used
20611 includes ultrasound guidance. DO NOT use for fluoro guidance
Major Joint Injection
Image- 08/30/16 fpnotebook.com

21. Viscous Supplementation
J7325- Hyaluronan or derivative, Synvisc or Synvisc-One, for intra- articular injection, 1 mg
Synvisc 48 mg injected = 48 units
J7324- Hyaluronan or derivative, Orthovisc, for intra-articular injection, per dose
J7321- Hyaluronan or derivative, Hyalgan or Supartz, for intra- articular injection, per dose
Viscous Supplementation

22. JW Modifier- MLN Matters MM9603
Currently use of JW modifier is at the MAC’s discretion.
Use of JW modifier required for claims with unused drugs or biologicals from a single use vial or single use package.
Must document the discarded drug or biological in the patient’s medical record when submitting claims with unused Part B drugs or biologicals
JW Modifier- MLN Matters MM9603

23. Botox Example J0585 onabotulinum toxin A J0585 – 155 Units
155 units administered
45 units wasted
J0585 – 155 Units
J Units –JW modifier
Learning-Network- MLN/MLNMattersArticles/Downloads/MM9603.pd
Botox Example

24. Resources ICD 10 updates JW Modifier
JW Modifier
Network-MLN/MLNMattersArticles/Downloads/MM9603.pd
Resources