# Percutaneous Lysis Of Epidural Adhesions



## NESmith (Jun 22, 2011)

Please tell me how you would code this procedure. Fluoroscopic evaluation of the lumbar region was undertaken with an AP image. Lumbar vertebral bodies were identified. The appropriate vertebral body was identified and the image was rotated antero-caudad until alignment of the endplates was identified. The image was rotated laterally until the neuroforamen was observed and it's maximum opening was noted. Appropriate skin markings were placed. The area was then prepped and draped in a sterile fashoin. .5 cc's of 1% lidocaine was injected in the subcutaneous tissue using a 25 ga 1 1/2 spinal needle at each corresponding level. At the L4 level on the left a 22 ga spinal needle was placed with gentle manipulation under fluoroscopic guidance until contact with the transverse process was noted. The needle was then redirected caudad and medially until placement in the neuroforamen was noted with an AP and lateral view of the fluoroscopic image was noted. The needle was noted in the upper pole of the formen and did not pass medically to the pedicle of the AP fluoroscopic view. After verification of the needle placement  a total solution or radiopaque material, omnipaque 300 mg/ml was injected in a slow contiuous fashion. An epiduralgram was interpreted and identified as follows:After negative aspiration to blood, air of fluids the contast material was injected in a slow and contiuous fashion. Spread of which was noted in the epidural space with a distorted fashion. Spread was noted in the caudad and cephalad direction with irregular spread out of the corresponding nueroforamina. This correlated with the preoperative diagnosis established. After interpretation of the epiduralgram a total solution containing 1 cc of preservative free normal saline and a total of 20 mg of depomedrol solution and 250 units of Vitrase for lysis of adhesion, which was confirmed preop with MRI and diagnostic studies, was included in the injectate. The procedure was repeated at the L5 and S levels in the exact same fashion as previously described. A total of 80 mg of depomedrol and 800 units of Vitrase solution was used among all levels. Lysis of epidural adhesions was performed with the medications and needle. 
Thank You for any help you can give me .


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## dwaldman (Jun 22, 2011)

Below is AMA description of procedure for CPT 62264

Description of Procedure

"After the appropriate preparation and consent, the patient is taken to the operating room or a sterile procedure room, where preparation is carried out with povidone-iodine prep. Draping is carried out to cover the patient, extending into the midthoracic or cervical region, even if the procedure is performed in the lumbosacral region. Appropriate monitoring is carried out, with monitoring of blood pressure and pulse and pulse oximetry. Sedation is slowly administered. The fluoroscope is adjusted over the lumbosacral region for anteroposterior and lateral views. A physician scrubbed and in sterile gown and gloves infiltrates the area for needle insertion with local anesthetic. After this, an RK needle is introduced into the epidural space under fluoroscopic utilization. After the needle placement is confirmed to be in the epidural space, a lumbar epidurogram is carried out using approximately 2 to 5 mL of contrast. Finding the filling defects by examining the contrast flow into the nerve roots is the purpose of the epidurogram. Intravascular or subarachnoid placement of the needle or contrast is avoided; if such malpositioning occurs, the needle is repositioned. After appropriate determination of epidurography, a Racz catheter, which is a spring-guided, reinforced catheter, is slowly passed through the RK needle to the area of the filling defect or the site of pathology determined by MRI scan, computed tomography scan, or patient symptoms. After the positioning of the catheter into the appropriate area, adhesiolysis is carried out by mechanical means. After completion of the adhesiolysis, a repeat epidurogram is carried out by additional injection of contrast. If appropriate adhesiolysis is completed, nerve root filling as well as epidural filling will be noted. At this time, variable doses of local anesthetic and steroid are injected. Five to 10 mL of 2% lidocaine hydrochloride or 5 to 10 mL of 0.25% bupivacaine is used for the local anesthetic. Additionally, hyaluronidase may be injected at this time. Deposteroid consisting of either 6 to 12 mg of Celestone or 40 to 80 mg of Depomedrol or another steroid is injected in the operating room or recovery room. After completion of the injection, the catheter is taped using bio-occlusive dressing; and the patient is turned to the supine position and transferred to the recovery room."


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## NESmith (Jun 23, 2011)

Thank You as always dwaldman for your great response. After reading your description of the procedure I do not feel the provider did CPT 66264 in the report I provided. He actually billed CPT codes 64483RT & 64484RT x 2 72275-59 J1040 & J3471. I was concerned becasue he mentioned lysis of epidural adhesions was performed with no mention of the cath and he billed for the J3471. I hope I am not missing something.


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## brockorama01 (Jun 27, 2011)

I do not believe you can bill for the 72275.  The fluoro you described appears to be nothing more than verification of needle placement....77003, not a true epiduragram.  Fluoro is bundled with 64483.

Brock Berta, CPC


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