Neurosurgery Coding Alert

Hint: Counting days is the key, coding experts say

Revisions to CPT in recent years allow precise reporting of treatment of spinal adhesions, but to file a clean claim you'll also need to know how to code associated procedures and which diagnoses to apply. For consistent claims success, rely on these six tips:
 
1. Learn About the Racz Procedure

Before you can code for epidural lysis of spinal adhesions - also known as the Racz catheter procedure - you'll have to know how to recognize it in an operative report.

The Racz catheter procedure is a treatment to provide pain relief when less invasive methods do not suffice, says Kee D. Kim, MD, associate professor of neurosurgery at University of California, Davis in Sacramento. During the procedure, the surgeon inserts a specially designed needle near the tailbone so he 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.

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

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

2. Code According to Procedure Days

You should select the appropriate procedure code for Racz according to the number of days that the surgeon provides treatment.

Prior to 2003, CPT had only one code for the Racz procedure: 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]). In 2003, CPT 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, says Margie Scalley Vaught, CPC, CCS-P, MCS-P, an independent coding specialist in Ellensburg, Wash., and a member of the American Academy of Professional Coders' national advisory board. Because the previous CPT descriptions did not mention procedural time frames, most physicians billed all procedures - regardless of the number of days involved - using 62263. This was contrary to AMA recommendations, however, and the revised definitions allow for much more precise reporting.

"In 2002, the AMA addressed 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 one-day procedure had its own valid code."

Remember: The number of days the catheter remains in place, not the number of adhesions the surgeon lyses, determines the appropriate code. CPT specifically states, "Code 62263 is not reported for each adhesiolysis treatment, but should be reported once to describe the entire series of injections/infusions spanning two or more treatment days." Similarly, "Code 62264 describes multiple adhesiolysis treatment sessions performed on the same day," CPT states.

Note, also, that 62263 and 62264 are exclusive. You may report only one code (and only a single unit of that code) at a time.

Coding example: If the surgeon inserts the catheter and leaves it in place for three days for continued treatment, you should report only one unit of 62263, regardless of the number of adhesions treated. Do not report, for instance, 62264 x 3.

3. Don't Bill Separately for Fluoroscopy

You should never bill separately for fluoroscopy or epidurography when reporting 62263 or 62264.

Until 2003, 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 NCCI did not include epidurography (72275, Epidurography, radiological supervision and interpretation) with the service. Now Racz codes 62263 and 62264 include both of these procedures. CPT likewise specifies that 76005 is an integral component of 62263 and 62264.

4. Use ICD-9s to Establish Medical Necessity

Both Medicare and third-party payers will accept a number of ICD-9 codes to establish medical necessity for 62263 and 62264, including many of the following (check with your individual payer for an exact list of accepted diagnoses):