Lower back pain is one of the most common issues that many working professionals face at some point in their lives. This pain usually goes away with painkillers. But sometimes the stubborn pain requires an epidural or subarachnoid injection to manage pain or treat various spinal conditions.
However, to bill these services, CPT code 62323 is used in pain management billing. If you want to gain more information about the billing and reimbursement of this code, you can refer to the details explained in this guide.
CPT Code 62323 – Description
CPT code 62323 is used to represent the administration of an epidural or subarachnoid injection into the lower spine by a needle or catheter. The physician injects a diagnostic or therapeutic material, such as a steroid or pain reliever, into the area surrounding the spinal nerves in the lumbar lower back or sacral tailbone regions using imaging guidance (fluoroscopy or CT).
Scenarios Where CPT Code 62323 is Applicable
Below are some relevant situations to gain a better understanding of CPT code 62323’s usage.
Persistent Lower Back Pain
For our first scenario, imagine a 45-year-old woman who experiences excruciating lower back pain. When she visits her nearest physician, she tells him that she has been feeling pain at the same spot for a few months. This pain was previously relieved temporarily with painkillers and some back exercises. But this time her pain is different and is not going away with all these techniques.
Her physician begins her treatment with an MRI. After analyzing the reports, he opts for a lumbar epidural steroid injection to address this persistent pain. He administers the injection using fluoroscopic imaging. Since the physician uses imaging to guide the needle to the correct space and injects a combination of steroids, he can use CPT code 62323 to bill his services.
Sciatica or Leg Pain
For our next example, consider a 58-year-old man. He has been experiencing severe sciatica pain for a few months. Once the pain becomes unbearable, he decides to see a physician. He explains the details of his pain, which starts in his lower back and travels down to his leg.
Previously, he took some medications along with regular physiotherapy, but the nerve pain continued to intensify. This time, his physician finally decides to treat his pain with a lumbar epidural steroid injection to alleviate inflammation around the affected nerve.
During the injection administration, the physician uses imaging to place the needle into the interlaminar epidural space. Therefore, the appropriate code to bill this service is CPT code 62323.
Spinal Stenosis
Let’s discuss the last example of a 70-year-old man who has been experiencing lumbar spinal stenosis for several years. Recently, the narrowing of his spinal canal and pain intensified. His physician thinks that a therapeutic lumbar epidural steroid injection can help alleviate inflammation and enhance his mobility.
The physician carefully places the needle within the epidural space to inject a steroid-based solution with the help of fluoroscopy imaging. Since this procedure is therapeutic and conducted with imaging in the lumbar area, the professional can bill the service with CPT code 62323.
Applicable Modifiers for CPT Code 62323
You can refer to the following modifiers that may apply to CPT code 62323 based on the circumstances.
Modifier 59
Modifier 59 is utilized to bill for an additional, separate procedure performed on the same day. If you are carrying out another distinct medical procedure for the same patient on the same date, you can apply this modifier. However, before you apply his modifier, you must ensure compliance with particular payers’ guidelines.
Modifier KX
Modifier KX helps to prove the medical necessity of the procedure because the diagnostic selective nerve root block (DSNRB) and epidural injection are performed under CPT code 62323. To distinguish between a therapeutic epidural injection and a DSNRB, you must use this modifier.
CPT Code 62323 – Billing & Reimbursement Guidelines
Below are some billing and reimbursement guidelines that you must follow for CPT code 62323.
Ensure Correct Application of 62323
How can you bill your services accurately when you have no clear understanding of the code? It is essential to understand the correct application of CPT code 62323. By now, you must be clear that this code is used for lumbar injections administered under imaging guidance. However, if the procedure was performed in the thoracic or cervical regions, it should be reported separately with its respective codes.
Furthermore, the code description highlights the inclusion of specific imaging guidance. Hence, you cannot bill fluoroscopy or CT separately. Otherwise, doing so will result in claim denials.
Fulfill the Documentation Requirements
How well you document your services will determine how much and how fast you are reimbursed. Your records must show that the procedure was medically necessary. These records must also be retained in the patient’s medical file and made available to the payer upon request.
Additionally, the essential components that CMS recommends you include in your documentation for CPT code 62323 are listed below.
- Patient identification details (e.g., full name, date of service).
- The readable signature of the physician or non-physician practitioner who provided care to the patient.
- The procedural report should adequately document the percentage of pain relief experienced immediately after the injection. Document the pre-procedure percentage as well.
- Include imaging with at least two views showing the final needle position, and ensure that contrast flow is documented and available upon request.
Follow the Payers’ Policies
Last but not least, the most crucial step while billing is reviewing the payer’s billing and reimbursement policies. Every payer has its own specific reimbursement rules for medical services. As a result, it is essential to ensure that your documentation complies with the payer’s requirements.
Final Word
To wrap things up, you should now know that CPT code 62323 refers to an interlaminar epidural or subarachnoid injection in the lower back for diagnostic or therapeutic reasons under imaging guidance.
Although we tried to cover the key information related to the code, including its applicable scenarios, modifiers, and reimbursement guidelines. Nevertheless, there may be circumstances in which our guidance may not satisfy your billing needs. Here, you always have the choice to opt for expert pain management billing services. These firms hire certified professionals who can masterfully resolve a range of billing issues, including CPT coding.
