Neurosurgery Coding Alert

Question: What is the appropriate code to describe a Racz procedure?


Missouri Subscriber

Answer: You should choose one of two codes for epidural lysis of spinal adhesions, also known as Racz catheter procedures: 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) or 62264 (... 1 day).

The Racz procedure provides pain relief when less invasive methods do not suffice. 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 surgeon to pinpoint problem spots where scar tissue might be preventing medications from reaching painful areas.

After the surgeon verifies the treatment location, he threads a flexible catheter through the needle to the scar site. Then he 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 catheter in place allows for subsequent daily injections to continue treatment. If the surgeon inserts and removes the catheter in the same day, report 62264. If the surgeon allows the catheter to remain in place for two or more days, report 62263.

Important: The number of days the catheter remains in place, not the number of adhesions the surgeon lyses, determines the appropriate code. "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," according to CPT guidelines. Similarly, "Code 62264 describes multiple adhesiolysis treatment sessions performed on the same day," CPT states.