Neurosurgery Coding Alert

Spinal catheters may pose a coding challenge if you do not know what to specifically look for in the clinical note. You need to confirm the approach and catheter handling to narrow your choice to the right code. Follow these tips to efficiently report the spinal catheters.

Your surgeon may be implanting a spinal catheter in a patient who needs infusions over a long period of time. For example, long-term intrathecal or epidural infusions may be required to treat chronic pain conditions. In such patients, your surgeon may 'tunnel' the epidural catheter subcutaneously and may attach the catheter directly to an external pump or through an implanted subcutaneous port.

If your surgeon placed a non-tunneled catheter, you would code the trial with either 62318 (Injection[s], including indwelling catheter placement, continuous infusion or intermittent bolus, of diagnostic or therapeutic substance[s] [including anesthetic, antispasmodic, opioid, steroid, other solution], not including neurolytic substances, includes contrast for localization when performed, epidural or subarachnoid; cervical or thoracic) or 62319 (Injection[s], including indwelling catheter placement, continuous infusion or intermittent bolus of diagnostic or therapeutic substance[s] [including anesthetic, antispasmodic, opioid, steroid, other solution], not including neurolytic substances, includes contrast for localization when performed, epidural or subarachnoid; lumbar or sacral [caudal]).

Check location: You select either of these codes depending upon the anatomical location where your surgeon placed the catheter in the spine. "The cervicothoracic placement is coded distinctly from lumbosacral placement because the cervicothoracic region contains the spinal cord, and placement of catheters in this region carries greater risk than in the lumbosacral spine," says Gregory Przybylski, MD, director of neurosurgery, New Jersey Neuroscience Institute, JFK Medical Center, Edison.

Before you report the spinal catheters, you first confirm if your surgeon did a laminectomy. Depending upon whether or not your surgeon did a laminectomy, you report codes 62351 (Implantation, revision or repositioning of tunneled intrathecal or epidural catheter, for long-term medication administration via an external pump or implantable reservoir/infusion pump; with laminectomy) or 62350 (Implantation, revision or repositioning of tunneled intrathecal or epidural catheter, for long-term medication administration via an external pump or implantable reservoir/infusion pump; without laminectomy).

Note: The codes 62351 and 62350 apply for the implantation, revision, or repositioning of the spinal catheters. You hence do not need to confirm how your surgeon handled the spinal catheter. The two codes also apply to both intrathecal and epidural catheters. Therefore, you may report these regardless of whether your surgeon placed the catheter in the epidural or intrathecal space.

After the implantation, revision, or repositioning of a tunneled spinal catheter, the patient may return for a follow-up examination of the catheter. Codes 62350 and 62351 have a global period of 10 days. If you read that the patient returned for follow-up during the global period, you report code 99024 (Postoperative follow-up visit, normally included in the surgical package, to indicate that an evaluation and management service was performed during a postoperative period for a reason[s] related to the original procedure).

To report follow-up after a non-tunneled catheter placement, you may check documentation to confirm the complexity of the problem and how long the evaluation lasted and accordingly report codes 99212 (Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A problem focused history; A problem focused examination; Straightforward medical decision making. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem[s] and the patient's and/or family's needs. Usually, the presenting problem[s] are self limited or minor. Physicians typically spend 10 minutes face-to-face with the patient and/or family) -- 99215 (Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A comprehensive history; A comprehensive examination; Medical decision making of high complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem[s] and the patient's and/or family's needs. Usually, the presenting problem[s] are of moderate to high severity. Physicians typically spend 40 minutes face-to-face with the patient and/or family).