Performing Different Type of Epidural Than Initial Authorization

[GatorCHOMPions]

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If I got authorization to perform an ILESI but failed to access the epidural space can I switch to a caudal on the spot? If so would I need to resubmit authorization afterward? Let's assume going to another IL level isn't an option.

What about ILESI to TFESI or vice versa? I understand consent could be an issue and I wouldn't break sterility and have the patient re-sign a new consent in the middle of the procedure.

 

[knoxdoc]

Caudal is billed the same as ILESI, so no problem there. Switching to TFESI CAN be an issue. When I have had to do it in the past, I would explain the need to change the injection in my procedure note, then contact my billing lady and let her know so that she could work on getting the auth changed. Usually not an issue.

 

[Agast]

LCD does not go into what procedure approach is best, just reasonable expectation that the med makes it to the target. Medical necessity is met

 

[SpineandWine]

LCD does not go into what procedure approach is best, just reasonable expectation that the med makes it to the target. Medical necessity is met

I’m confused here
Are you saying you can switch from 62323 to 64483 on day of if you believe 64483 is indicated and you got approval for 62323

 

[Agast]

I’m confused here
Are you saying you can switch from 62323 to 64483 on day of if you believe 64483 is indicated and you got approval for 62323

No, that is not what I’m saying. OP said they failed to access the epidural space with the first approach tried. It is reasonable and medically appropriate to target the same space with a different approach, assuming the signed consent allows for this.

 

[Laryngospasm]

My understanding has always been caudal and ILESI are ok to be substituted but not TFESI

 

[SpineandWine]

My understanding has always been caudal and ILESI are ok to be substituted but not TFESI

Yes, they are both 62323

 

[mille125]

Yes, they are both 62323

Agree with what others have said. There are both 62323.

If you switch to 64483, it may get denied but it also my not.

 

[Ducttape]

I’m confused here
Are you saying you can switch from 62323 to 64483 on day of if you believe 64483 is indicated and you got approval for 62323

no.

you can change level of interlaminar epidural injection (including caudal) but you cant switch to TFESI. as noted above, you get approval for 62323 not 64483.

 

[No_Pain_No_Gain]

If I got authorization to perform an ILESI but failed to access the epidural space can I switch to a caudal on the spot? If so would I need to resubmit authorization afterward? Let's assume going to another IL level isn't an option.

What about ILESI to TFESI or vice versa? I understand consent could be an issue and I wouldn't break sterility and have the patient re-sign a new consent in the middle of the procedure.

This is dependent on the payer and authorization which was obtained. If this was a medicare patient, then you should be fine as long as you clearly document your reasoning and what occurred. However, if this was a payer that authorizes a specific level (and there are a handful of common payers that do this), then switching like this would entail authorization afterwards. You would need to have very good communication with whoever obtains your authorizations. Sometimes they will be able to obtain that auth day of, and sometimes they will be unable to obtain that authorization for that date and you/the practice will end up eating the cost and not getting reimbursed. If you work within a large hospital system and are compensated primarily on a wRVU basis, the financial implications may not directly affect you. However, if you own your practice or your compensation is tied to collections, this becomes a very important consideration. Ultimately, each situation should be evaluated individually based on the patient's insurance plan and the specific authorization that was obtained.