Coding transforaminal epidural steroid injection

When reporing facet joint codes, you may not bill separately for the image guidance. Whether using fluoroscopy or computed axial tomography, guidance is required. If ultrasound guidance is used for the above procedures, the CPT® codebook states that you must report the facet joint injection using 0213T-0218T Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with ultrasound guidance… . If no imageing is used, you must report 20552-20553 Injection(s); single or multiple trigger point(s)….

Your fluoroscopic guidance, one of the concerns of course in using the fluoroscopy is that the medication won't reach that target level. And you definitely need to use fluoroscopy for transforaminal. More often, physicians are using it in chronic pain for the translaminar also.  An epidurogram during your initial injection, the first time you inject it in the epidural space may be warranted. Fluoral guidance is bundled into all of these codes. So you want to be careful with that and make sure documentation supports it for error free medical coding and billing.

Kenalog in blood - Derby et al. "Size and aggregation of corticosteroids used for epidural injections"

  • Depo-Medrol also formed large aggregations in the study by Tiso et al [6]
  • Celestone Soluspan formed large aggregations only in the Derby et al study  [7 ]
  • It is speculated that these large aggregates occlude smaller vessels, and thus lead to infarction .
  • Injection of methylprednisolone vs dexamethasone vs prednisolone into the vertebral artery of pigs – see summary of study here

    Coding transforaminal epidural steroid injection

    coding transforaminal epidural steroid injection

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