Anesthesia Coding Alert

New procedures and techniques are constantly being added to the field of medicine. And although patients and providers often welcome these advances, finding a code that represents adequate reimbursement for the provider and is accepted by the carrier may be another story. One such example is spinal endoscopy, a procedure that does not have a CPT code assigned to it. Anesthesia providers should be able to receive adequate reimbursement by choosing from several coding options, establishing medical necessity and working with local carriers to file with their preferred codes.


Coding Spinal Endoscopies


Some anesthesia providers are just beginning to get involved with spinal endoscopies and are still searching for the most appropriate codes for proper reimbursement. Consider using these codes and modifiers, but check with your local carrier for its preference:

CPT 62263 percutaneous lysis of epidural adhesions using solution injection (e.g., hypertonic saline, enzyme) or mechanical means (e.g., spring-wound catheter) including radiologic localization (includes contrast when administered). This code includes fluoroscopic guidance and epidural injection components.

Modifier -22 unusual procedural services. We plan to use this modifier with claims because this is a much more difficult procedure than the RACZ catheter procedure, says Jann Lienhard, CPC, of the physician group Bergen Pain Management in Paramus, N.J. (The RACZ, or epidurolysis, procedure is used to dissolve some of the scar tissue from around entrapped nerves in the epidural space of the spine, so medications such as cortisone can reach the affected area.) The modifier would be used in addition to a primary code such as 62263.

CPT 72275 epidurography, radiological supervision and interpretation. This code may be considered for interpretation of the procedure when the provider dictates a formal radiological supervision and interpretation report and makes it part of the patients record. Carriers may allow this code to be used in addition to code 62263.

Modifier -26 professional component. Use this modifier as applicable in conjunction with 72275 if someone other than the performing physician owns the equipment.

64999 unlisted procedure, nervous system. Some carriers prefer this code for reporting spinal endoscopy for the percutaneous lysis of epidural adhesions.

01999 unlisted anesthesia procedure. We dont like using this one because its always better to be more specific with coding, but sometimes this is the only code carriers will accept for a procedure, says Lewis Woodell, director of reimbursement and compliance in the anesthesia billing office of Summit Healthcare in Fort Worth, Texas.

Lienhard adds that her group also will be billing for myelography (72240-72270) and/or fluoroscopy (76005) when [...]