Epidural injections are common in interventional pain management. However, they are challenging to bill. One type of epidural medication is billed via CPT code 62321. Many billers get this code wrong. That’s why we have prepared this comprehensive guide on 62321 billing.
We will discuss what code 62321 is, how it is used practically in real-world scenarios, and important billing guidelines. So, let’s start.
CPT Code 62321 – Description
CPT code 62321 is defined as:
“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; with imaging guidance (i.e., fluoroscopy or CT).”
Code 62321 is a Pain Management billing code. It is used when physicians insert medication, usually corticosteroids and local anesthetics, into the epidural space that surrounds the nerve roots in the cervical or thoracic spine. The code can be used for both diagnostic and therapeutic purposes.
However, an essential point to note here is that imaging guidance is mandatory for CPT code 62321. Imaging is required to help physicians place the needle and medications with pinpoint accuracy. Additionally, 62321 should not be used for the administration of neurolytic substances or chemotherapy.
The following is a summary of all the important points:
- Single injection per session, limited to one level
- Interlaminar approach (between vertebral laminae)
- Mandatory imaging guidance for Medicare coverage
- Cervical or thoracic anatomic location
- Diagnostic or therapeutic intent
Scenarios Where CPT Code 62321 is Applicable
Billing CPT code 62321 can be confusing. So, let’s make things easy with a couple of real-world scenarios in which this code can be used:
Radiculopathy
For our first scenario, let’s suppose a 45-year-old patient visits a medical practice. He is feeling severe pain that is radiating from his neck to his fingers. He tells the physician that he is feeling persistent numbness and weakness in his arm. During the assessment, he also shared that he has been facing these symptoms for over a month, and painkillers and physiotherapy are not helping.
Based on all the symptoms, the physician suspects irritation in the cervical spine, a condition known as cervical radiculopathy. To provide targeted pain relief, the physician administers an epidural injection of corticosteroid medication into the cervical spine using fluoroscopic guidance. In this scenario, the billing department can bill the administration process via CPT code 62321 supported by ICD-10 code M54.12.
Intervertebral Disc Stenosis
Suppose a 62-year-old patient visits the clinic with ongoing neck pain that spreads into both shoulders. His imaging tests show that a bulging disc is narrowing the spinal canal and putting pressure on the nerves. This condition is called intervertebral disc stenosis of the neural canal. Since physical therapy and medications haven’t helped much, the physician decides to perform a cervical epidural steroid injection using fluoroscopic guidance to reduce the inflammation and relieve his symptoms.
The medical billing department codes and submits the claim for reimbursement. In this case, CPT code 62321 is used along with ICD-10 code M50.12.
Applicable Modifiers for CPT Code 62321
CPT code 62321 is a high reimbursement code. That’s why modifiers must be used with care. Otherwise, your claims will be denied, and consistent mistakes can trigger audits.
Depending upon the circumstances, many modifiers can be used with 62321. However, the most vital of these is the KX modifier. Diagnostic Selective Nerve Root Blocks (DSNRBs) are very similar to epidural injections. Modifier KX distinguishes between the two. This modifier indicates that the medical necessity criteria for a DSNRB have been met.
CPT Code 62321 – Billing & Reimbursement Guidelines
The following are some essential points to consider to reduce your denial rates:
Provide Comprehensive Documentation
Like all other CPT codes, justifying medical necessity is vital for 62321 claims. Without proper documentation, your claims will be rejected. The documentation requirements for each provider may vary. We recommend providing the following details:
- Medical necessity justification with conservative treatment failure.
- Baseline pain scores and functional assessments.
- Procedural reports documenting imaging guidance and needle placement.
- Post-procedure pain relief percentages and duration.
- Films demonstrating the final needle position and contrast flow.
Be Mindful of Session Limitations
Medicare allows a maximum of four epidural injection sessions per anatomic region in a rolling 12-month period. This limitation applies to all epidural codes (62321, 62323, 64479, 64480, 64483, 64484) within the same anatomic region, regardless of the number of levels treated.
Verify the Medicare Reimbursement Rate
According to the latest Medicare Physician Fee Schedule, the national average reimbursement for CPT code 62321 is $251.01 in non-facility settings and $103.83 in facility settings.
However, this rate varies significantly for each Medicare Administrative Contractor (MAC) locality. You can check the exact amount for your MAC via the PFS Lookup Tool.
Wrapping Up
Finally, we have reached the end of our guide. Let’s briefly go through everything we have discussed in this blog.
CPT code 62321 is an essential Pain Management code. It applies to an epidural or subarachnoid injection in the cervical or thoracic spine performed with imaging guidance. For proper reimbursement, always include detailed documentation with your claims and remember the billing limitations.
However, medical billing is complex. If you are facing frequent denials or want a helping hand, you can connect with our experts at MediBillMD for expert pain management billing services.
