Neurology & Pain Management Coding Alert

Question: Can you tell me what codes you would use for this clinical scenario?

POSTOPERATIVE DIAGNOSIS: Herniated L3-4 disk left and L3-4 disc with stenosis and L4-L5 cyst with sequestered disc LS-SI.

Patient had progressive history of back and especially left leg pain from an auto accident.

The skin was anesthetized 12 cm lateral to the midline over the posterior iliac crest, parallel to L3-4 disc space with 1 % Xylocaine. Small skin incision was made and then a #22-gauge spinal needle was obliquely passed down in the Codman’s triangle and posterior margin. At the L3-4 disc space we entered the disc space with a curved and endoscopic cannula. The probe was easily be able to move across and posterior in the disc space and in the midline and approximately 1cc to 1.5cc of disc material was removed. After this disc being done, an #18 gauge needle was used to approach the L5-S1 disc space from a superior-posterior angle view and a #22 gauge Chiba was then passed in the disc space. Dye was injected into the disc space and there was no communication from the disc space through the posterior margin of the canal where fragment had been seen on MRI scan.

Florida Subscriber

Answer: You should first report 62287 (Decompression procedure, percutaneous, of nucleus pulposus of intervertebral disc, any method utilizing needle based technique to remove disc material under fluoroscopic imaging or other form of indirect visualization, with discography and/or epidural injection(s) at the treated level(s), when performed, single or multiple levels, lumbar) for the decompression. Then, report 62290 (Injection procedure for discography, each level; lumbar) for the discography.

Important: Append modifier 59 (Distinct procedural service) to 62290 to show that the discography injection and the disc decompression were separate services. Also, always be sure to append modifier 59 to the lower-paying code or it will cost you; payers will reduce reimbursement for the code with modifier 59 appended.