Epidural steroid injection is performed to reduce the inflammation and pain associated with
nerve root compression. Nerve roots can be compressed by a disc
herniation/bulge, Lumbar or cervical spinal stenosis, and other spine-related
conditions which lead to nerve compression.
A needle is inserted into the epidural space (The epidural space is the outermost part of the spinal canal, located
outside the dural membrane) under imaging guidance (CT or fluoroscopy) to
administer steroid.
Cervical epidural injection
is performed in the neck provide relief to nerve roots in the neck.
Thoracic epidural injection
is performed in the thoracic provide relief to nerve roots in the Thoracic.
Lumbar
epidural injection is performed at the lower back provide relief to
nerve roots in lumbar.
A Radiologist will perform the epidural injection;
however orthopaedic surgeon or neurosurgeons may also administer it.
Any imaging that is performed during the epidural steroid
injection procedure itself will conclude with the procedure, no follow-up image
interpretation is required.
Interlaminar epidural or
subarachnoid Injection:
Single
Injection – Injecting
substances at one or more levels and then removing the catheter.
§ Cervical or Thoracic
62320
– without imaging guidance
62321
- with imaging guidance
§ Lumbar or Sacral
62322 – without imaging guidance
62323 - with imaging guidance
Infusion
(Continuous) – The catheter is left in place to
deliver substances over a prolonged period.
§ Cervical or Thoracic
62324 - without imaging guidance
62325 - with imaging guidance
§ Lumbar or Sacral
62326 - without imaging guidance
62327 - with imaging guidance
Billing Guidelines:
1. Guidance included.
2. Coded only once based on region at which the
needle entered the body.
Transforaminal Epidural Injections:
CPT 64479 - Injection(s), anesthetic agent and/or steroid, Transforaminal
epidural, with imaging guidance (fluoroscopy or CT); cervical or
thoracic, single level
CPT +64480 - each additional level
CPT 64483 - Injection(s), anesthetic agent and/or steroid, Transforaminal
epidural, with imaging guidance (fluoroscopy or CT); lumbar or sacral,
single level
CPT +64484 - each additional level
Billing Guidelines:
1. Guidance included.
2. For Transforaminal epidural injection under
ultrasound guidance – 0228T – 0231T
3. For bilateral procedure: CPT 64479 / 64483 – add modifier 50, But not
with add on codes (64480 or 64484) instead bill it twice.