Neurosurgery Coding Alert

Question: I’m having trouble with some of the terminology when coding injection/drainage/aspiration of the spinal cord. Specifically, the terms for approach and visualization are confusing me. Could you give me a rundown of the different types of approaches/ visualizations I might see in an operative note?

Arizona Subscriber

Answer: It’s important to know the different types of visualization and approach techniques your provider is using, as it will affect code choice. If you don’t get the visualization/approach type right, you risk choosing the wrong code and opening the path to denials and appeals.

The key: “The primary approach and visualization define the service, whether another method is incidentally applied,” according to CPT^® 2021.

Stop the rejections before they start with this primer on approach/visualization techniques your neurosurgeon might use when performing injection/drainage/aspiration of the spinal cord:

Visualization Types

Indirect visualization: This term defines image-guided visualization; for example computed tomography (CT) or fluoroscopy.

Direct visualization: This term defines light-based visualization. It “can be performed by eye, or with surgical loupes, microscope, or endoscope.

Approach Types

Percutaneous: This defines image-guided procedures “performed with indirect visualization of the spine without the use of any device that allows visualization through a surgical incision,” CPT^® states.

Endoscopic: This defines spinal procedures that use an endoscope to provide direct visualization of the spine.

Open: This term defines a spinal procedure with “continuous direct visualization of the spine through a surgical opening,” according to CPT^®.

So let’s say the neurosurgeon performs a percutaneous decompression procedure, removing disc material with a needle. They also use fluoroscopy for guidance. For this service, you’d 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).