# Help with Pain Management - Can anyone tell me what the CPT



## NESmith (Apr 4, 2013)

Please help as soon as anyone can.

Can anyone tell me what the CPT codes are for catheter revision of a morphine pump catheter, evacuation of a seroma and seal of a CSF leak.
Patient has a CSF leak or seroma on his morphine catheter entry site. The seroma is not getting any bigger and it is quite large measuring about 12 cm x 10 cm and sticks out a good 5 cm.

Thank You for your help in this matter.


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## dwaldman (Apr 5, 2013)

62350 Revision of intrathecal catheter
10140 Evacuation of seroma

Codes such as 22010 or 22015 are more invasive procedure requiring open surgical approach. 63707 would also be open surgical approach involving stitching of the dura and per NCCI would be bundled with other spinal procedures if occurs during the procedure. If a blood patch 62273 would be performed in addition to 62350 it would be bundle per NCCI.



NCCI Policy Manual
11. If a dural (cerebrospinal fluid) leak occurs during a spinal procedure, repair of the dural leak is integral to the spinal procedure.  CPT code 63707 or 63709 (repair of dural/cerebrospinal fluid leak) should not be reported separately for the repair. 

63707 Repair of dural/cerebrospinal fluid leak, not requiring laminectomy 

62350 Implantation, revision or repositioning of tunneled intrathecal or epidural catheter, for long-term medication administration via an external pump or implantable reservoir/infusion pump; without laminectomy  

10140 Incision and drainage of hematoma, seroma or fluid collection 

AMA CPT Changes 2006

Rationale Codes 22010 and 22015 were established to report incision and drainage of osterior deep spinal abscesses. The codes are differentiated according to region: cervical, thoracic, or cervicothoracic (22010) and lumbar, sacral, or lumbosacral (22015). 

Rationale Codes 22010 and 22015 were established to report incision and drainage of posterior deep spinal abscesses. The codes are differentiated according to region: cervical, thoracic, or cervicothoracic (22010) and lumbar, sacral, or lumbosacral (22015). An exclusionary parenthetical note following these codes indicates the mutually exclusive nature of these procedures, precluding the ability to report both codes for the same session. An exclusionary parenthetical note was added to restrict the use of these codes in conjunction with the postoperative incision and drainage code 10180 and the spinal instrumentation codes 22850 and 22852. A cross-reference directs the users to 10060 and 10140 to report superficial incision and drainage of hematoma of unspecified locations. Incision and drainage at the thoracolumbar junction would be reported with the code describing the region where the majority of the work is performed.

Clinical Example (22010) A 47-year-old man underwent C3-C7 posterior spinal fusion. Two months postoperatively, he presents febrile with erythema, drainage of the neck wound, and neck pain. He undergoes incision and drainage of a deep abscess of the cervical spine. 

Description of Procedure (22010) A posterior approach to the spine is performed using the prior midline incision, which may require extension. The deep fascia is incised. Cultures are obtained. The midline wound is widely opened, irrigated, and debrided. Hematoma, necrotic tissue, and/or purulent collections are carefully debrided and the entire field irrigated using copious amounts of fluid. Hemostasis is obtained and the wound is closed over drains that are packed open or closed over a wound vacuum device. A sterile dressing is applied. 

Clinical Example (22015) A 51-year-old woman underwent L4-S1 posterior spinal fusion. Seven weeks postoperatively, she presents febrile with erythema, drainage of the back wound, and back pain. She undergoes incision and drainage of a deep abscess of the lumbar spine. 

Description of Procedure (22015) A posterior approach to the spine is performed using the prior midline incision, which may require extension. The deep fascia is incised. Cultures are obtained. The midline wound is widely opened, irrigated, and debrided. Hematoma, necrotic tissue, and/or purulent collections are carefully debrided and the entire field irrigated using copious amounts of fluid. Hemostasis is obtained and the wound is closed over drains that are packed open or closed over a wound vacuum device. A sterile dressing is applied."


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