# 62264 lysis of adhesions question - adhesiolysis sessions



## tschrader (Mar 24, 2015)

I am wanting to some clarification on this code. As it states in the CPT book multiple adhesiolysis sessions for one day. So if the provider is injecting for one session, do you still use this code or another code. I have dictation samples where its only one injection done not multiple sessions. Of course the doctor states that this is the code to use. Here is an example of the dictation that he dictates:

Pre/Post Procedure Diagnosis: 
1. Lumbar Intervertebral Disc Disease
2. Lumbar Spinal Stenosis
3. Lumbar Radiculopathy
4. Chronic Low Back Pain
5. Failed Back Surgery Syndrome / Postlaminectomy Syndrome

Procedure: 
1. Caudal Catheter Epidural Steroid Injection with Lysis of Adhesions
2. Fluoroscopic Needle Localization

Procedure Summary:

The risks and benefits of the procedure were discussed with the patient who agreed to proceed via written consent. The patient was escorted to the fluoroscopy suite and placed in the prone position on the procedure room table. The sacral region was cleaned with chlorhexidine x 3 then draped in the usual sterile fashion. A time out was performed to confirm this was the correct patient, procedure, and location. All pressure points were checked, padded, and verbal communication was maintained with the patient throughout the procedure. 

Lateral fluoroscopy was used to identify the sacral hiatus. The skin and subcutaneous tissue overlying the area was anesthetized with 1% Lidocaine. A 16-gauge RX epidural needle was then advanced percutaneously through the anesthestized skin tract under fluoroscopic guidance into the caudal epidural space. Next, a RX brevi catheter was advanced under intermittent fluoroscopy to the L5 vertebral level. After negative aspiration for blood or CSF, a volume of 2 mL of Omnipaque 180 was injected under live fluoroscopy. This revealed good epidural spread, with no evidence of loculation, vascular run-off, or intrathecal spread. Subsequently, a volume of 5 mL of hyaluronidase for adhesiolysis followed by _5 mL of 15 mg of dexamethasone_ mixed with 1 mL of bupivacaine and normal saline was injected without resistance. The catheter and needle were removed as a single unit and the catheter tip was noted to be intact. A bandage was applied over the needle entry site and the patient was escorted to recovery.
The patient tolerated the procedure well and and there were no complications. After being monitored post-procedure, the patient was discharged to home in stable condition without any new neurologic deficit. 



Thank you!


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## dwaldman (Mar 24, 2015)

" including multiple adhesiolysis sessions"

What is being described with the above statement is that "IF" multiple adhesiolysis sessions are performed on a single calendar day, CPT 62264 is only reported once. They are not indicating that multiple adhesiolysis procedures have to be performed to report CPT 62264.

So if a single session is performed on a single calendar day, it would be appropriate to report CPT 62264.


AMA CPT Assistant June 2012
Spine and Spinal Cord

 62263

Percutaneous 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. 

Below is from AMA CPT Changes 2003


Revisions were made to code 62263 for CPT 2003 to identify this code as a percutaneous epidural adhesiolysis procedure including multiple adhesiolysis sessions performed over two or more days. An additional revision to the descriptor deleted the reference to a ?spring wound? type of catheter from the parenthetical note providing examples of mechanical lysis.

New code 62264 was created to specifically address a percutaneous epidural adhesiolysis procedure, including multiple adhesiolysis sessions, performed on a single day. The procedure is essentially the same as described for 62263 but takes place on one day rather than on multiple days.

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


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## tschrader (Mar 25, 2015)

Thank you so much for that information!! This helps alot!


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