Anesthesia Coding Alert

Question: We have a patient who was treated with epidural injections of hypertonic saline and Wydase to alleviate pain due to the build-up of scar tissue around the lumbar nerve roots. How should I code this?

Missouri Subscriber

Answer: Depending on the procedure's length, the best coding option when your pain specialist performs lysis of epidural adhesions is either 62263 (Percutaneous lysis of epidural adhesions using solution injection [e.g., hypertonic saline, enzyme] or mechanical means [e.g., catheter] including radiologic localization [includes contrast when administered], multiple adhesiolysis sessions; 2 or more days) or 62264 (... one day).

Experts note: Adhesions are bands of scar-like tissue that form between two surfaces within the body. Adhesions in the epidural space result in spinal nerve entrapment within the dense scar tissue, increasing the nerve root's susceptibility to compression or tension.

A hypertonic saline and enzyme injection to "dissolve" epidural adhesions is also known as a "lysis of epidural adhesions." Epidural adhesiolysis sessions can be performed over a single-day or multiple-day period using either solution and/or mechanical means.

More about the codes: Codes 62263 and 62264 are inclusive of everything involved in these procedures -- including all injections of contrast and radiologic guidance, such as fluoroscopy and epidurography -- so you won't report additional codes for these services.

Proceed with caution: You need to be aware that many carriers consider epidurolysis to be an investigational procedure and will not reimburse for it. It always pays to play it safe and check with your individual carriers to clarify their specific policies before scheduling and/or billing for this procedure.