# Neuroplasty and lysis of epidural adhesions



## Talibah (Jun 26, 2010)

Greetings all: One of my pain docs has dictated a report stating he performed a neuroplasty and lysis of epidural adhesions. When I read the body of the report, he makes no mention of the lysis, but only talks about injection hypertonic saline at each joint.
 Should this be coded as 62264 or should I go with 62319? The procedure was performed using a catheter, but again no mention of lysis of adhesions. 

I welcome any and all responses.

Michelle D. Hinton


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## gost (Jun 28, 2010)

If possible, I would ask the doc for clarification.  Since the difference in reimbursement will probably be significant, he may agree to do an addendum to the op report.  Otherwise, I think you would have to go with 62310 in the absence of documentation of the adhesiolysis.


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## dwaldman (Jun 28, 2010)

"Marcaine 0.25% 10 cc was used for local infiltration. Caudal 18 G NEEDLE was inserted into the sacral hiatus upto S3 level under flouro with AP & Lateral views --- epidural catheter was inserted thro the needle into the caudal canal up to L4 level. Isovue 200 5-10cc was injected to demonstrate epidurogram & to determine the epidural placement of the catheter . After negative aspiration of the catheter --- 2 cc Lidocaine 2% was given as test dose for spinal anesthesia & there was no signs of anesthesia. After 3 min --- 200 units of hyaluronidase(Vitresse) were injected followed by 10 cc of Marcaine 0.25 + Kenalog 40 mg .. After 3 min -- 15CC NACL 5% SOLUTION was injected slowly in 10 miunutes . Epidural catheter was anchored to the skin & dressed sterile. Pt was monitored in recovery room for 30-45 min before returning the Pt to hospital room."

I don't think because in the body of the op report, the doctor does not include the words "lysis of adhesions" would make it seem that you would need to bill 62319. What was the patient scheduled to have? And like the other post if you have contact with the physician I would ask him. Here is an example where the wording Lysis is not in the body of report but this procedure note represents a lysis of epidural adhesions being performed.


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## Talibah (Jun 29, 2010)

Thank you all for your replies.
The report states:

"A #17 -gauge Tuohy needle was inserted into the skin guided by fluroscopy towards the caudal canal, Epidurogram confirmed placement of the needle tip. Insertion of epidural catheter all the way to the left L3 was done. An injection of 1cc of hypertonic saline followed by 1cc of lidocaine 0.5% and the catheter was withdrawn to the L4 and L5 and the same procedure was repeated in the same fashion. Then, the catheter was withdrawn. An injection of 1cc of hypertonic saline followed by 6cc of lidocaine 0.5% and 10mg of kenalog was completed. The needle was withdrawn. Patient went to recovery room in stable condition with no complications."

Under the heading "Procedures performed" the physicians lists 
1. Needle localization with fluoroscopy
2. Three level left sided lumbar neuroplasty @ L3, L4, and L5
3. Epidural lysis of adhesions
4. Lumbar epidural steroid injection w/ fluoro and epidurogram

Based on the procedure note, were all of these things done?
What if any is the difference between neuroplasty and adhesiolysis?

Thank you,

Michelle


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## gost (Jun 29, 2010)

I agree with dwaldman that the op note does not have to say "lysis of adhesions" or be that specific.  I would be tempted to go ahead and code the lysis since the doc did mention the saline injection and we know it is used in that procedure, especially since the lysis is listed in the "procedures performed."  However, in hypertonic saline neurolysis, the saline solution is injected into the epidural space _after _the nerve root has been separated from the scar tissue.  Since the doctor did not mention this step, I think I would still ask for clarification.  If nothing else, asking now might insure the same question doesn't come up again.


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