(2023) CPT 62323 | Description, Guidelines, Reimbursement & Billing Examples

CPT 62323 can be used when the Physician administers diagnostic or therapeutic substance or injection such as an 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.

Description Of CPT 62323

The official description of CPT code 62323 is: “Injection(s), of diagnostic or therapeutic substance(s) (e.g., anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, including needle or catheter placement, interlaminar epidural or subarachnoid, lumbar or sacral (caudal); with imaging guidance (ie, fluoroscopy or CT)”.

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. 

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.

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.

Billing Guidelines

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

If chemotherapy administration (96450) bills with CPT 62323, it is inappropriate to bill the 62323 CPT code separately.

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

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. 

Billing Examples

The following are some billing examples of the 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 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 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 whether the tumor had metastasized. 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 it is getting worse daily. 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 pain medicines 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 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.