CPT 62323

(2022) CPT 62323 Description, Guidelines, Reimbursement, Modifiers & Examples

CPT 62323 bills for service when the Physician administers diagnostic or therapeutic substance or injection such as anesthetic, steroid, antispasmodic, opioid, or other solution and not including neurolytic substances, including needle or catheter placement, interlaminar epidural or subarachnoid, lumbar, or sacral (caudal); with imaging guidance such as fluoroscopy or CT.

CPT 62323 Description

The following are the reasons why the Physician performs CPT 62323:

Lumbar disk displacement 

Lumbar disk degeneration

Radiculopathy of the lumbar region

Lumbar spondylosis

Lumbar spinal stenosis

Localized low back pain

Neurogenic claudication

The Physician administers medicine or substance via injection into the space around the spinal cord for diagnostic or therapeutic purposes for pain management or other problems related to the spinal cord. 

The Physician places the patient in a sitting or lateral decubitus position to insert the needle into the vertebral interspace of the lumbar or sacral region. The Physician first sterilizes the target site, administers the local anesthesia, and places the needle. 

The Physician then injects the substance or solution, excluding neurolytic substances, to provide a therapeutic or diagnostic outcome. The Physician administers the solution to the interlaminar epidural or subarachnoid space. 

The Physician may remove the needle and apply a dressing on the wound after completing the procedure. CPT 62322 bills when the Physician performs the without imaging guidance and bill CPT 62323 with imaging guidance. 

62323 cpt code

CPT 62323 bills for service when the Physician administers diagnostic or therapeutic substance or injection such as anesthetic, steroid, antispasmodic, opioid, or other solution and not including neurolytic substances, including needle or catheter placement, interlaminar epidural or subarachnoid, lumbar, or sacral (caudal); with imaging guidance such as fluoroscopy or CT.

CPT 62323 Reimbursement

A maximum of one unit can be a bill on the same service date of CPT 62323. In contrast, the Three units allow documentation supporting the service’s medical necessity. 

The cost and RUVS of 62323 CPT code are $107.67 and 3.11123 when performed in the facility. In contrast, the reimbursement and RUVS of CPT 62323 are $306.91 and 8.86873 when performed in the non-facility.

CPT 62323 Modifiers  

The following are the list modifiers applicable with CPT 62323: 

22, 23, 47, 51, 52, 53, 54, 55, 56, 58, 59, 62, 63, 76, 77, 78, 79, 80, 81 82, 99, , AS, CC, CR, ET, EY, GA, GC, GK, GR, GU, GY, GZ, KX, Q5, Q6, QJ, SG, TC, XR, XP, XU, XS, AI, AQ, AR. 

Modifier 47 is applicable 62323 CPT code when the surgeon administers general or regional anesthesia to the patient. It is not appropriate to report modifier 47 with anesthesia procedures.

Modifier 76 is appropriate with CPT 62323 when a similar service performs by the Same Physician on the same service date. 

Modifier 54 is applicable with CPT 62323 when the Physician provides surgical care only. In contrast, Modifiers 55 and 56 attach to CPT 62323 when the Physician performs post-management and preoperative care only. 

Modifier 76 is applicable with CPT 62323 when a similar service performs by a different Physician on the same service date. 

Modifier 59 is applicable with 62323 CPT code when a Distinct service performs by the Physician and bundled with another procedure on the same date.   

Modifier X {E, P, S, U} is applicable instead of Modifier 59 with CPT 62323 when service bills to Medicare insurance. It divides the modifier into four parts for further specification of the procedure. 

Modifier 53 will be reported with CPT 62323 if an unsuccessful attempt for an injection makes due to unavoidable circumstances like allergic reactions to the substance. 

Modifier 22 applies to CPT 62323 when services perform longer than usual and take extra resources during the procedure. 

Modifier 23 is applicable with 62323 CPT code when general or local anesthesia administers by the Physician and routinely does not require during the procedure. 

Modifier 52 applies when the Physician does not complete the immunization service and terminates due to unavoidable circumstances. 

If physicians believe that Medicare will deny such service, reporting with a GA modifier is appropriate. The beneficiary must sign an Advance Beneficiary Notification (ABN), and CPT 62323 must apply the GA modifier to that service.

CPT 62323 Billing Guidelines

Documentation should support the medical necessity of service. It reflects that service is medically necessary and appropriate.  

The following are ICD 10 Payable Dx codes when 62323 CPT code bills: 

M43.28, M46.45, M46.46, M46.47, M47.15, M47.16, M47.25, M47.26, M47.27, M47.28, M47.815, M47.816, M47.817, M47.818, M47.895, M47.896, M47.897, M48.05, M48.061, M48.062, M48.07, M51.15, M51.16, M51.17, M51.25, M51.26, M51.27, M51.35, M51.37, M51.36, M51.86, M51.87, and M51.45. 

M51.46, M51.47, M51.85,M53.2X7, M53.2X8, M53.3, M53.86, M53.87, M53.88, M54.15, M54.16, M54.17, M54.50, M54.51 M54.40, M54.41, M54.42, M54.59, M99.23, M99.33, M99.43, M99.53, M99.63, and M99.73

CPT 62323 includes Radiologic guidance such as 76942, CPT code 77003, and 77012, and It is not appropriate to report guidance separately.

If chemotherapy administration (96450) bills with CPT 62323, It is not appropriate to bill 62323 CPT code separately.

Documentation should indicate the injection level and the substance(s) administered. If the procedure performs without radiologic guidance, it is appropriate to report 62322 instead of 62323.

Suppose the same Physician performs evaluation and management (E/M) service for a reason related to surgery. It is not appropriate to report E/M CPT code 99202-99499 separately.

If the same Physician performs E/M (99202-99499) for a condition unrelated to surgery, It is appropriate to report with modifier 25

62323 CPT Code Examples

The following are examples of 62323 CPT code when performed by the Physician:

Example 1

A 60-year-old female presents with low back pain for four days to the office. The pain gets worse with movement and when lying down. The patient took some medication for pain. 

The physical exam revealed swelling in the Lumbar region. The Physician ordered a CT Lumbar spine. It shows degeneration of the lumbar spine at L1 – L4, L5– S1, and disk budging at the L5-L6 level. The patient also has spondylosis of the lumbar spine. The patient denies any other symptoms such as headache, numbness, urinary problems, nausea, vomiting, and shortness of breath. 

The Physician administers the steroid injection via transforaminal epidural space for pain management. 

Example 2

A 16-year-old male presented to the emergency department after a motor vehicle accident today and had a severe headache, back pain, and chest pain. The patient is unable to move and has severe low back pain. 

The patient denies urinary symptoms, extremity pain, and dizziness, and the physical exam revealed neck and eye swelling. The Physician ordered a CT of the Lumbar, head, and chest. 

The patient had multiple fractures of L2-L3 and L5 and S1 levels. The Physician orders an anesthetic agent for pain management of the lumbar region.

Example 3 

A 39-year-old male with tumors on the lumbar region presented to the emergency department with c/o constant low back pain that started four days ago. The patient was unable to walk for 1-week. 

The patient is consulted with his primary care physician and suggested to go emergency department. Denies trauma, heavy palpitations, dizziness, cough, recent illness, fever, chills, back pain, abdominal pain, nausea, recent travel, known sick contacts, current antibiotic use, near-syncope or syncope, changes in stool color, urinary complaints, or any other symptoms. 

The Physician decides to do a surgical procedure to excise cancer. The patient took his routine medication. The Physician ordered a CT scan of the lumbar region and laboratory studies to confirm if the tumor metastasized or not. The procedure performs successfully.

 On the second day of surgery, the patient was back with severe pain and decided to administer an anesthetic agent at L4-45 in the epidural space. 

Example 4

A 76-year-old male presents to the office for radiculopathy and stenosis of the lumbar region. A patient has had severe low back pain since last week. 

The patient took some medication for pain but is getting worse day by day. He denies trauma, heavy palpitations, dizziness, cough, recent illness, fever, chills, back pain, abdominal pain, nausea, recent travel, known sick contacts, current antibiotic use, near-syncope or syncope, changes in stool color, urinary complaints, or any other symptoms. 

The lumbar region CT scans revealed spondylosis at the L2-L3 level, disc protrusion at the L4-L5 level, and degenerated changes at the L5-S1 region. 

The patient requested the Physician for pain management as he could not bear it. The Physician prescribed medicines for pain and scheduled an appointment for a follow-up visit. The Physician ordered a steroid injection in the epidural space at the L4-L5 level, and he got relief from the pain. 

Example 5

A 65-year-old female presents to the office with low back pain for four days. The pain gets worse with movement and when lying down. The patient took some medication for pain. 

The patient denies any other symptoms such as headache, numbness, urinary problems, nausea, vomiting, and shortness of breath. A physical exam revealed swelling in the Lumbar region. 

The Physician ordered a CT Lumbar spine. It reveals degeneration of the lumbar spine at L1-L5, L5– S1, and disk budging at the L2-L3 level. The patient also has spondylosis of the lumbar spine. The Physician administers steroid injection via transforaminal epidural space for pain management. 

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