Your cervical, thoracic and lumbar epidurals can all be approached using the interlaminar or it may be referred to as a translaminar technique. The nomenclature that we use is recommended by the ISIS, International Spinal Injection Society. And they like the precise anatomic descriptors – transforaminal and interlaminar.
A number of providers do use this term, translaminar. This injection is performed through a pair of medium or a midline approach where that epidural needle just penetrates the skin and subcu tissue and it goes literally midline into the epidural space.
Medical Coding Example: Suppose an x-ray picture that you might see through fluoroscopic guidance fluoroscopy film, shows that needle that goes straight up through the midline. Then you know, you have a caudal block and that caudal block is placed right through the sacral gap. It's a space right at the end of the lumbar spine near the sacrum.
This is probably one of the most low risks procedures because the dura ends and you're not likely to end up with a sacral puncture. The dura ends at S2 and there won't be that risk of the sacral puncture.
Probably the disadvantage of it according to some providers is that it does require a higher volume of medication usually 10 to 15 ccs of medication to reach all the way up to the L4, L5 level. And because that large area is anesthetized, providers generally feel that if you're trying to use this caudal block for diagnostic purposes, you're going to get a limited result because the physician is actually anesthetizing a very large area.
One of the things that these epidural injections are for is to diagnose the actual location that the pain is generating from. So, that’s a primary reason to do these as well as a therapeutic.
So the CPT medical coding and billing options for the interlaminar epidural - and remember, if a doctor does refer to a translaminar, it's going to be the same code. It's 62310 for your cervical and thoracic and it's 62311 for your caudal or sacral. These codes include the injection of every substance that is injected through that needle with the exception of a neurolytic. So, phenol or alcohol – that’s a neurolytic substance.
But if dye is injective for use with the fluoro that’s included in the one needle placement and injection and opioid, the anesthetic, the steroid – any substance that’s injected through that needle nothing is billed separately. They're all included. So even if it's incrementally, that needle is there and even if incrementally they inject different substances, it's just one code, 62310 or 62311.
Medical Coding Training Tip: As far as the neurolytic injections go, the neurolytic destruction using chemicals to promote analgesia have been extensively used in the early part of the 20th century to manage pain. But with an advent of newer analgesics and the development of other safer techniques for pain management, its use has markedly diminished.
The reason that it's a serious matter to code as neurolytic when there is no neurolytic injection being performed is dollars. They pay significantly more money. And the dollars are up – it's called upcoding. We rarely see if ever have seen a neurolytic injection, phenol or alcohol use for treatment of radicular pain just from, you know, like your strain or a disc disruption.
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