Anesthesia Coding Alert

Controversy has surrounded Racz catheter coding for years because of different opinions regarding one-day versus three-day procedures. New and revised codes for the procedure in 2003 make some aspects of coding easier, but you still have questions and challenges to address.

Be Familiar with the Procedure

Patients with back pain often try a variety of procedures with little or no relief. The Racz catheter procedure also known as epidural lysis of adhesions may help some of these patients find the relief they've been searching for.

During the Racz procedure, a specially designed needle is inserted near the tailbone so the doctor can inject contrast dye. The dye spreads into the epidural space, allowing the physician to pinpoint problem spots where scar tissue might be preventing medications from reaching painful areas.                                       

 Once the physician verifies the treatment location, he or she threads a flexible catheter through the needle to the scar site. Then the doctor alternately injects an anesthetic, steroids and hyaluronidase (a drug that helps break down scarring).  

 He or she removes the needle after the procedure, but the catheter can remain in place for up to three days. Leaving it in place allows for subsequent daily injections to continue treatment.

Code According to Procedure Days

Previous versions of CPT had only one code for the Racz procedure: 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]). CPT Codes 2003 revised the descriptor for 62263 to include the designation "multiple adhesiolysis sessions; 2 or more days" and added 62264 ( 1 day) as a new companion code.           

 Because the old CPT descriptions did not mention procedural time frames, most physicians billed all days as a one-day procedure. The insurance company didn't know this unless it required a review of notes. If carriers required prior authorization of the procedure, they advised physicians to code with 64999 (Unlisted procedure, nervous system).                                                                                       

 "Last year, the AMAaddressed the issue by asking physicians who performed the one-day procedure to use 62263 with modifier -52 (Reduced services)," says Trish Bukauskas-Vollmer, CPC, owner of TB Consulting in Myrtle Beach, S.C. "But many practices weren't doing this. It was only a matter of time until the new one-day procedure had its own valid code."                                                      

Another important distinction between past and present coding relates to fluoroscopy and epidurography. Until this year, the National Correct Coding Initiative (NCCI) bundled fluoroscopy (76005, Fluoroscopic guidance and localization of needle or catheter tip for spine or paraspinous diagnostic or therapeutic injection procedures [epidural, transforaminal epidural, subarachnoid, paravertebral facet joint, paravertebral facet joint nerve or sacroiliac joint], including neurolytic agent destruction) with the Racz procedure, but CCI did not include epidurography (72275, Epidurography, radiological supervision and interpretation) with the service. Now Racz codes 62263 and 62264 include both of these procedures.

Another key point to remember is that the Racz procedure has a 10-day global period. Many providers and coders are unaware of this, Bukauskas-Vollmer says, so they lose reimbursement by having the patient return for a checkup in seven to nine days.

The changes with 62263 and 62264 make coding for Racz procedures more straightforward, and practitioners can more accurately report services. The primary concern now is that 62264 is not on the new ASC (ambulatory surgery center) facility list, but practitioners hope it will be added as the code is used.