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Coding for Pain Management Injections in the ASC Setting  

By: Paul Cadorette, CPC, COC, CPC-P, COSC, CASCC, Director of Education, nimble solutions
Watch the Anatomy of Coding Pain Management Procedures coding course on demand. Register here.

Pain management injections are a crucial aspect of healthcare. They can make a significant difference in patients’ lives and provide relief from various types of pain. 

However, to ensure accurate coding for these procedures in the ASC setting, it’s essential to understand the nuances within each type of injection.  

Our 2023 Pain Management Injection Procedures course course, available for on-demand viewing, addresses common ASC coding challenges challenges.

In this blog post, I’ll provide you with a preview of topics and techniques covered in this course, including CPT codes for a variety of pain injection approaches. 

Mastering Epidural Injections

Epidural injections are a common method for managing pain, especially for conditions like back pain and sciatica.  
During our coding course, you’ll learn about three approaches to epidural injections: 

  • Intralaminar: A direct midline approach to the epidural space between the lamina is crucial in managing spinal pain. 
  • Caudal: This method involves inserting a needle or catheter through the sacral hiatus to access the epidural space. 
  • Diagnostic Selective Nerve Root Block (DSNRB): A lateral approach through the intervertebral foramen is employed for diagnostic selective nerve root block procedures. 

We’ll review more about the CPT codes associated with these three approaches and why Epidural Injections (CPT 62320-62323) or Indwelling Catheter (CPT 62324-62327) refer to intralaminar and caudal while the Transforaminal Epidural (CPT 64779-64484) refers to the DSNRB approach.

Understanding Paravertebral Facet Injections

Paravertebral facet injections are another essential aspect of pain management. During our course, you’ll gain knowledge about various services reported using the paravertebral facet injection codes (CPT 64490-64495), including: 

  • Direct Facet Joint Injections 
  • Medial Branch Blocks 
  • Injection of Pars Defect 
  • Atlanto-occipital/Atlanto-axial Joint Injections

Dealing with SI Joint Injections

The sacroiliac (SI) joint can be a significant source of pain for many patients. We’ll also cover SI joint injections and the associated nerve innervations during the course:

SI Joint Injections (G0260): Injection directly into the sacroiliac joint.

Nerves Innervating the SI Joint (64451): Injection of the L5 dorsal ramus and S1-S3 lateral branch nerves.

Additionally, you’ll learn how to code these procedures correctly based on the nerves being treated.

With respect to nerves innervating the SI joint, if ALL of these nerves are not treated, you would report CPT 64493 for the L5 dorsal ramus and CPT 64450 for each lateral branch nerve injected. Injection of L5 dorsal ramus and S1 lateral branch nerve would be coded as CPT 64493, CPT 64450 rather than CPT 64451.

Image Guidance: A Must-Have

All the injections we discuss in our course require the use of image guidance. The course will provide insights into the importance of image guidance in ensuring accurate and medically necessary procedures. We’ll delve into the guidelines set by Medicare LCDs, emphasizing fluoroscopy as a crucial component. 

Trigger Point Injections

During the course, we’ll explore the coding aspects of trigger point injections and discuss scenarios where they are applied.

For example, when facet joint or sacroiliac joint injections are performed without image guidance, you’d report the trigger point injection codes 20552/20553.

Other instances where trigger point injection codes are reported would be for piriformis muscle injections, pelvic floor injections, or chemodenervation procedures.

Biologics and Final Takeaways for Pain Management Injection

The 2023 Pain Management Injection Procedures coding course underlines the significance of adhering to FDA-designated substances when it comes to biologics, including amnio or PRP.

Mixing these substances with anesthesia will be discussed, as well as emphasizing that injections involving non-FDA-designated substances are considered experimental.

I look forward to covering these topics in depth with you during the Pain Management Injection Procedures Coding Course.

This blog post outlines some of the topics covered in the 2023 Pain Management Injection Procedures coding course, available on demand with corresponding AAPC continuing education units included.