Here's a review of the new and revised pain management codes your coders will need to master in order to maximize reimbursement and minimize compliance risk. Most of the changes involve the intent of the code descriptors.

Epidural steroid injection revisions
CPT made some minor changes to the codes for epidural steroid injections performed in the epidural space or subarachnoid space for 2012. The change in verbiage of these codes is meant to clarify that you can use the 62310 (cervical or thoracic) or 62311 (lumbar) procedures for either a single-needle injection or if a catheter is placed to administer one or more injections on a single day. Conversely, use 62318 and 62319 (depending on the spinal level) for placement of an indwelling catheter that is left in place to administer injections over a prolonged period of time — either continuously or by intermittent bolus injections.

The following codes have been clarified:

• 62310 Injection(s), of diagnostic or therapeutic substance(s) (including anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, including needle or catheter placement, includes contrast for localization when performed, epidural or subarachnoid; cervical or thoracic.
• 62311 Injection(s), of diagnostic or therapeutic substance(s) (including anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, including needle or catheter placement, includes contrast for localization when performed, epidural or subarachnoid; lumbar or sacral (caudal).
• 62318 Injection(s), including indwelling catheter placement, continuous infusion or intermittent bolus, of diagnostic or therapeutic substance(s) (including anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, includes contrast for localization when performed, epidural or subarachnoid; cervical or thoracic.
• 62319 Injection(s), including indwelling catheter placement, continuous infusion or intermittent bolus, of diagnostic or therapeutic substance(s) (including anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, includes contrast for localization when performed, epidural or subarachnoid; lumbar or sacral (caudal).

Radiofrequency procedure code changes
As you'll see in the table to the right, reimbursement for paravertebral facet joint nerve destructions appears to increase slightly in 2012 as compared to 2011. The AMA stated in making this change that there are 2 nerves that innervate each facet joint and 2 facet joints at each vertebral level. The unit of service is a single facet joint in the new codes, rather than a vertebral level, so if both facet joints at the same vertebral level are treated, bill the applicable code with bilateral procedure modifiers. Codes 64622, add-on 64623, 64636 and add-on 64627 for radiofrequency procedures performed on facet joints have been deleted. Instead, 4 new codes — 64633 to 64636 — have been established to reflect the work and anatomical site involved when performing these destructions.

Other pain management code revisions
Fluoroscopy descriptor. Code 77003 for fluoroscopic guidance and localization of needle or catheter tip for spine or paraspinous diagnostic or therapeutic injection procedures (epidural or subarachnoid) has been revised for 2012. The words "(or sacroiliac joint), including neurolytic agent destruction" were eliminated from the coding descriptor.

Spinal cord neurostimulator. Code 64561 for the percutaneous implantation of neurostimulator electrode array of the sacral nerve (transforaminal placement) is used for InterStim procedures, usually performed for overactive bladder (Stage I Trial procedures) has been revised to add the word electrode "array," instead of just electrode. The word "array" was also added to codes 64553, 64555, 64565, 64575, 64580, 64581 and 64585.

Electrode arrays. CPT has issued the guideline to use new Category III codes 0282T to 0284T when implanting trial or permanent electrode arrays or pulse generators to be used for peripheral subcutaneous field stimulation procedures.

• 0282T Percutaneous or open implantation of neurostimulator electrode array(s), subcutaneous (peripheral subcutaneous field stimulation), including imaging guidance, when performed, cervical, thoracic or lumbar; for trial, including removal at the conclusion of trial period.
• 0283T Percutaneous or open implantation of neurostimulator electrode array(s), subcutaneous (peripheral subcutaneous field stimulation), including imaging guidance, when performed, cervical, thoracic or lumbar; permanent, with implantation of a pulse generator.
• 0284T Revision or removal of pulse generator or electrodes, including imaging guidance, when performed, including addition of new electrodes, when performed.
  The same change was made to code 64581 for incision for implantation of a neurostimulator electrode array of the sacral nerve (transforaminal placement) for the Stage II permanent InterStim procedure, where the word "array" was added to the code descriptor.
• Code 64585 for the revision or removal of a peripheral neurostimulator electrode array also added the word "array" to the code descriptor. There was no change to the code (64590) for 2012 for the implantation of the generator/battery used in the permanent Stage II procedure.