Awareness : Did You Know? 2015-2016

Did You Know? Weekly Educational Series 16

For the Week of December 7, 2015

Interlaminar Epidural Injections and Modifier 50

Question:When a physician/practitioner administers more than one interlaminar epidural injection in the same spinal region, should they append modifier 50?

Answer:No, you should not append modifier 50 (Bilateral procedure) or modifiers RT (Right side) or LT (Left side) to injection codes 62310 or 62311 (Injection, single [not via indwelling catheter], not including neurolytic substances, with or without contrast [for either localization or epidurography], of diagnostic or therapeutic substance[s] [including anesthetic, antispasmodic, opioid, steroid, other solution], epidural or subarachnoid ...).

Here’s why:When a physician/practitioner injects a substance into the epidural space via an interlaminar approach, the drug diffuses into the entire area. The spreading eliminates the need to inject medication into both sides of the space to achieve the desired results. Therefore, you won’t need to include modifier 50 on the claim or bill 62310 or 62311 more than once to document that the physician/practitioner treated the complete space.

The Medicare physician fee schedule backs up this interpretation of the code and service by indicating that the 150 percent fee adjustment for bilateral procedures does not apply for these codes. Instead, if you append 50 or RT/LT, you will receive the lower of:

  • the total actual charge for each side
  • the fee schedule amount for one unit of the billed code