Neurosurgery Coding Alert

Check with your payer before you report endoscopic procedure. 

You won’t find it too challenging to report epidural adhesiolysis if you know how to construe the operative note to confirm what your physician did. Here is how you can flawlessly report this procedure and earn your deserved payment. 

1. Do Not Limit Yourself to One Day

Your surgeon may continue the procedure of adhesiolysis over a period of time. Carefully read through the operative note to determine the number of days the catheter remains in the anatomical location. You will choose the right code depending upon how many days the procedure was done. Accordingly, you select from code 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) and 62264 (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; 1 day). 

Report only once: You report code 62263 only once regardless of the number of days in total. The same applies to code 62264 that is for one day only.  “This pair of codes distinguishes the patient in whom the catheter is placed and removed the same day compared with the patient in which the catheter remains for at least one night,” Przybylski says.

Example: If you read in the operative note that the surgeon inserted the catheter which was left in place for three days and the treatment was continued, you report a single unit of 62263, regardless of the number of adhesions treated. You do not report this procedure as 62264 x 3.

Do not count adhesions: You count the days and not the adhesions. Codes 62263 and 62264 are reported to describe the entire series of injections/infusions spanning the total number of treatment days.

Do not report 62263 and 62264 together: Remember that codes 62263 and 62264 are exclusive. You report only one code at one time. You also report only a single unit of a particular code at a time.

2. Fluoroscopy Is Inclusive in 62263 and 62264

When reporting, 62263 or 62264, you do not separately bill for fluoroscopy or epidurography. CPT® describes these procedures as integral to codes 62263 and 62264. You would not report 72275 (Epidurography, radiological supervision and interpretation) with codes 62263 or 62264.  “This is another example of the trend in CPT® to bundle image guidance that is needed to perform a particular procedure,” Przybylski says.

3. Check Payer Preferences for Spinal Endoscopy

In a resistant case of intractable pain, your surgeon may decide to go in for an endoscopy to visualize and lyse the adhesions in the epidural space. Here is an example of an operative note for spinal endoscopy.  “This type of procedure would be reported with unlisted code 64999.  Some payers may not cover this service, identifying it as investigational,” Przybylski says.

Example: A guide wire was inserted into the spinal canal under mild sedation. Then an endoscopic catheter was introduced. The adhesions were visualized and identified. Hypertonic saline was injected to break the adhesions. These were further broken away using the probe tip. The nerve roots were probed with the tip of the probe to ensure successful break-up of visible adhesions. Steroids were subsequently injected into the intrathecal space around the nerve roots.

Do not lose payment: Many payers refuse payment for spinal endoscopy as they may consider the procedure to be investigational and not covered under the diagnosis and treatment of non-responding low-back pain. You may need precertification for some. “However, just because a procedure is reported by a Category III code or unlisted code, it does not mean the procedure will always be considered a non-covered service.  Communication with the carrier is critical to explain the basis for the recommended procedure and any supportive literature, if available, to support the recommendation,” Przybylski says.