# Caudal epiduram lysis of adhesions under fluoroscopy



## LaVoncye (Jul 29, 2013)

Please Help
I have a claim that has been denied. It was coded by the senior coder as follows
62264
62311 59
77275 26, 59

This is the note with the procedure from the dr.
Procedure performed
Caudal Epidural lysis of adhesions under fluoroscopy
Caudal epidural steroid injection #3 under fluoroscopy
Lumbar epidurogram

The only line paid was the 62264 the rest were denied by medicare.

The coder is no longer her so I am trying t figure this out.
I was thinking that the coding should be as follows

62311 
72275 26

Or 62264 , 72275 26 because it says Lysis of the epidural lesions with injection of solution/ Mechanical Methods.

His note stated that under fluoroscopy  and lateral imaging the caudal epidural space was identified, lidocaine was used for topical infiltration and a 37 gauge introducer needle was slowly and incrementally advanced into the caudal epidural space and the epidurogram showed superior  spread.

Afterwards the agilecath was navigated in a cephalad manner, it was taken up to the inferior aspect of L3 at which point in time there was significant scar tissue and the catheter was not able to be advanced any further. We tried to advance the catheter in a central manner however it did veer towards the left side slightly and this could not be adjusted any further due to the scar tissue. Upon reaching this area a solution was injected in order to carry out the lysis of adhesions, other medications were injected as the catheter was with withdrawn.

Can some please help me?


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## dwaldman (Jul 30, 2013)

Below is from June 2012 AMA CPT Assistant, They shouldn't be adding the 59 modifier to 62311 since it is inclusive to inject steroid/anesthetic to a lysis and 72275 is bundled per AMA also.

.......When scar tissue forms around the nerves in the spinal canal, these nerves can become fixed into one position and cause significant swelling in the nerve root. Therefore, scar tissue in the spinal canal can be an important source of lower back and radiating pain. 

Epidural neuroplasty, which is also known as epidural neurolysis or lysis of adhesions, is the breaking up of scar tissue in an effort to help reduce the compressive effects of scar tissue in the spinal canal and allow medications such as steroids to reach the affected areas to improve and reduce pain. 

Spine and Spinal Cord

 62263Percutaneous lysis of epidural adhesions using solution injection (eg, hypertonic saline, enzyme) or mechanical means (eg, catheter) including radiologic localization (includes contrast when administered), multiple adhesiolysis sessions; 2 or more days

 62264 1 day

Code 62263 describes a percutaneous epidural catheterbased treatment involving targeted injection of various substances (such as hypertonic saline, steroid, and anesthetic) or mechanical adhesion lysis. The lysis procedure is coupled with epidural injection of contrast material to define areas of scarring around nerve roots and/or spinal nerves as well as swollen nerves that might indicate moderate to severe inflammation. 

Because the injection of contrast material and fluoroscopic guidance and localization are considered inherent in the services described by codes 62263 and 62264, it is not appropriate to additionally report code 77003, Fluoroscopic guidance and localization of needle or catheter tip for spine or paraspinous diagnostic or therapeutic injection procedures (epidural or subarachnoid) In codes 62263 and 62264, a flexible catheter is introduced through the needle into the epidural space. After the catheter tip is inserted, it is carefully maneuvered in the epidural space around bands of scar tissue until it is in the focal scar tissue at the target spinal nerve/nerve root. A contrast injection is then performed to confirm needle tip or catheter location, and to determine the degree of free flow liquid in the epidural space (ie, to determine areas of scarring in the epidural space). 

The treatment goal is to break down scar formation (adhesions), reduce edema, reduce inflammation, and block propagation of nociception (pain transmission) to the central nervous system. Although this treatment technique may involve several different injection treatments that occur over a several-day period, code 62263 should be reported only once. Per the code descriptor, injection of contrast material is considered inclusive of code 62263. 

Both codes 62263 and 62264 should be reported only one time for the entire series of injections, infusions, or mechanical lysis procedures performed, not per adhesiolysis treatment. For code 62263, this treatment series will span two or more treatment days, but the code would still be reported only one time. 


Coding Tip

The codes for percutaneous lysis of adhesions (62263 and 62264) include the procedures defined by codes 72275 and 77003; therefore, codes 72275 and 77003 should not be used in conjunction with codes 62263 and 62264.


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