Anesthesia Coding Alert

Question: Our physician performed peridural adhesiolysis with fluoroscopy, but the separately reported 77003 portion was denied. What happened? Kansas Subscriber Answer: Peridural adhesiolysis, also referred to as a RACZ procedure, uses one of two codes in CPT Codes: • 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 • 62264 -- . . . 1 day Radiologic guidance, such as fluoroscopy, is standard in the performance of the adhesiolysis procedure, which is used to treat pain stemming from scar tissue in the epidural space. Note that the CPT code descriptor for the therapeutic procedure states "including radiologic localization (includes contrast when administered)," so you can't report 77003 (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) separately. And CPT 2008's parenthetical notes indicate that codes 62263 and 62264 include codes 72275 and 77003. Additionally, Correct Coding Initiative (CCI) edits consider the fluoroscopic guidance (77003) as a component of the more comprehensive adhesiolysis procedure codes, 62263 and 62264.