# Denial of 62264 - Using 62311, 62319 & 62282



## gr8gal61 (Feb 11, 2013)

I am very new to the anesthesia / pain management arena however I was just approached by a fellow co-worker that prior to the procedure of 62264 it gets verified & approved however when the EOB comes in, Medicare pays yet some of the other payors are not calliing it "experimental". She then said the biller is then correcting the claim to 62311, 652282 & 62319. HELP does anyone know the correct way to bill this? AMA CPT 2013 clearly states 62318or 62319 should not be used in conjunction with 62310 or 62311. I need direction to get these claims paid. thanks


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## dwaldman (Feb 12, 2013)

That is misrepresentation to change the codes after the denial. If the carrier's medical policy states they do not cover lysis of epidural adhesions (62264 or 62263) then it simply a learning experience that carrier does not cover it. The major private payers are going to have in writing they do not cover it. When you have in writing that the carrier does not cover the procedure under no circumstances can you change to codes so that you can receive reimbursement.


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## mitchellde (Feb 12, 2013)

I agree you cannot just change the codes to something payable.. Can I ask though what dx code (s) are on your claim, not just the one(s) linked to the procedure but all listed on the claim.
experimental procedure does not mean it is a non covered service, but it could have something to do with the dx codes used.


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## dwaldman (Feb 12, 2013)

Below is from Cigna, Aetna, and BCBS policy that states they do not cover it. Although CPT 62282 might seem similar to CPTs 62264 or 62263. It comes down to the physician performed a lysis epidural adhesions which has it's own CPTs codes 62264 or 62263. By selecting 62282 you are bypassing there medical policy to receive payment and as stated above misrepresenting the service provided. I would let the one that does compliance with the group you work with that they need to address this with the employee who believes they can merely change the code. And follow that everyone is on the same page. That misrepresenting a service is something that is not acceptable.


OTHER PROCEDURES Cigna does not cover ANY of the following procedures because each is considered experimental, investigational or unproven (this list may not be all-inclusive):   
• devices for anular repair (e.g., Incloseâ„¢ Surgical Mesh System, Xcloseâ„¢ Tissue Repair System (Anulex Technologies, Inc., Minnetonka, MN) • endoscopic epidural adhesiolysis  (CPT code 64999) • epiduroscopy, epidural myeloscopy, epidural spinal endoscopy (CPT code 64999) • intervertebral disc biacuplasty /cooled radiofrequency (CPT code 22899) • intradiscal electrothermal annuloplasty (e.g., intradiscal electrothermal therapy [IDETâ„¢]) (CPT codes 22526, 22527) • intradiscal and/or paravertebral oxygen/ozone injection  • percutaneous epidural adhesiolysis, percutaneous epidural lysis of adhesions, Racz procedure (CPT codes 62263, 62264) • percutaneous intradiscal radiofrequency thermocoagulation (PIRFT), intradiscal radiofrequency thermomodulation or percutaneous radiofrequency thermomodulation (CPT code 22899, HCPCS code S2348) 

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Experimental and Investigational Interventions

Aetna considers any of the following injections or procedures experimental and investigational: 
Coccygeal ganglion (ganglion impar) block for coccydynia, pelvic pain, and all other indications;
Dynamic stabilization (e.g., Dynesys Spinal System, Graf ligamentoplasty/Graf artificial ligament, and the Stabilimax NZ Dynamic Spine Stabilization System);
Endoscopic laser foraminoplasty, endoscopic foraminotomy, laminotomy, and rhizotomy (endoscopic radiofrequency ablation);
Epidural fat grafting during lumbar decompression laminectomy/discectomy;
Epidural injections of lytic agents (e.g., hyaluronidase, hypertonic saline) or mechanical lysis in the treatment of adhesive arachnoiditis, epidural fibrosis, , failed back syndrome, or other indications;
Epiduroscopy (also known as epidural myeloscopy, epidural spinal endoscopy, myeloscopy, and spinal endoscopy) for the diagnosis and treatment of intractable LBP or other indications;
Facet chemodenervation/chemical facet neurolysis;
Facet joint implantation;
Far lateral microendoscopic diskectomy (FLMED) for extra-foraminal lumbar disc herniations or other indications;
Interlaminiar lumbar instrumented fusion (ILIF);
Inter-spinous and interlaminar distraction (e.g., the Aspen spinous process fixation system, the Coflex interlaminar stabilization spinal implant, the Coflex-F implant for minimally invasive lumbar fusion, Eclipse inter-spinous distraction device, ExtenSure bone allograft inter-spinous spacer, X-Stop device, and the TOPS System) for spinal stenosis or other indications;
Khan kinetic treatment (KKT);
Laser facet denervation;
Microendoscopic discectomy (MED) procedure for decompression of lumbar spine stenosis, lumbar disc herniation, or other indications;
Microsurgical anterior foraminotomy for cervical spondylotic myelopathy or other indications;
Minimally invasive/endoscopic cervical laminoforaminotomy for cervical radiculopathy/lateral and foraminal cervical disc herniations or other indications;
Minimally invasive lumbar decompression (MILD) procedure for lumbar canal stenosis or other indications;
Minimally invasive transforaminal lumbar interbody fusion (MITLIF) for lumbar disc degeneration and instability or other indications;
NuFix facet fusion;
OptiMesh grafting system;
Percutaneous endoscopic diskectomy with or without laser (PELD) (also known as arthroscopic microdiskectomy or Yeung Endoscopic Spinal Surgery System [Y.E.S.S.]);
Piriformis muscle resection;
Racz procedure (epidural adhesiolysis with the Racz catheter) for the treatment of members with adhesive arachnoiditis, epidural adhesions, failed back syndrome from multiple previous surgeries for herniated lumbar disk, or other indications;
Radiofrequency denervation for sacroiliac joint pain;
Radiofrequency lesioning of dorsal root ganglia for back pain;
Radiofrequency lesioning of terminal (peripheral) nerve endings for back pain;
Radiofrequency/pulsed radiofrequency ablation of trigger point pain;
Sacroiliac fusion or pinning for the treatment of LBP due to sacroiliac joint syndrome; Note: Sacroiliac fusion may be medically necessary for sacroiliac pain due to severe traumatic injury, where a trial of an external fixator is successful in providing pain relief;
Sacroplasty for osteoporotic sacral insufficiency fractures and other indications;
TruFuse facet fusion;
Vesselplasty (e.g., Vessel-X);
Xclose Tissue Repair System.
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Investigational and Not Medically Necessary:

Lysis of epidural adhesions by any means, including but not limited to, use of hypertonic saline injections, mechanical catheter manipulation, hyaluronidase, whether done with or without steroids or analgesics, is considered investigational and not medically necessary.


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## gr8gal61 (Feb 12, 2013)

Dwaldman & Debra, 
Thank you for the information. I am so new to this arena and office that I am still trying to figure out the billing systems. I will pass this beneficial info on to my co-worker and see what is truly happening.


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