Orthopedic Coding Alert

Tip: Decompressions can include 2 codes.

In past issues of Orthopedic Coding Alert, we’ve included guidance on the conventions of disc decompression and discography coding.

In this first issue of 2020, we’ll shed more light on these procedures via two clinical scenarios, courtesy of  a coder who’s seen a lot of these claims.

Quick Disc Decompression/Discography Primer

First, we’ll briefly review the parameters for each type of procedure and the corresponding codes. 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) for disc decompressions; and code injection for discography procedures with either 62290 (Injection procedure for discography, each level; lumbar) or 62291 (... cervical or thoracic), depending on encounter specifics.

Short and sweet: The 62287 code represents a corrective procedure, while 62290/62291 are diagnostic procedures.

The Cases

Basics: The following case studies represent two distinct encounters: disc decompression and disc decompression with discography.

Take a look at a pair of clinical scenarios that can make lucid how to code each of these encounters.

Case 1: Disc Decompression

Denise Caposella, CPC, senior consultant with Acevedo Consulting Incorporated in Delray Beach, Florida, provides us with our 62287 encounter:

Patient suffers from herniated disc of L4-5 and LS-S1 levels. The provider preps and drapes the patient’s lower back and identifies L4-5 disc space. The provider then injects local anesthesia using lidocaine 1% with epinephrine; she uses a #25-gauge 1.5-inch needle to reach the superficial skin and subcutaneous tissue. Then, she introduces a 150 mm Stryker needle in the direction of the L4-5 intervertebral space.

This successfully penetrates the disc and aims to the center of the disc at L4-5 in both AP and lateral views. Once this is accomplished under fluoroscopy, the provider removes the trocar from the needle and inserts the Stryker decompressor so that approximately 1.5 to 2 g of the disc material are removed with the decompressor. The provider accomplishes two passes of 90 seconds each. After the passes, the provider removes the instruments from the space and passes all the disc material through the scrub technician.

Then, the provider introduces the 150 mm Stryker needle in the direction of the L5-Sl intervertebral space; she successfully penetrates the space under fluoroscopy. She then removes the trocar from the needle, inserts the Stryker decompressor, and removes approximately 1.5 to 2 g of disc material with the decompressor. The provider accomplishes two passes of 90 seconds. After the passes, the provider removes the instruments from the space and passes all the disc material through the scrub technician.

Once the patient wakes up, he is taken to the recovery room in satisfactory condition.

Coding: You’ll report 62287 for this encounter.

“Because the CPT^® descriptor of code 62287 includes the term ‘single or multiple’ levels, only one unit of 62287 is assigned even when the procedure is performed on more than one level,” Caposella explains.

Case 2: Discography/Disc Decompression Combo

Again, Caposella gifted us with a detailed clinical scenario; in this one, the provider performs a discography and a disc decompression:

A patient suffers from a herniated L3-4 disk left and L3-4 disc with stenosis, and L4-L5 cyst with sequestered disc LS-SI. Notes indicate that the patient had a progressive history of back and left leg pain from an auto accident.

The provider anesthetizes the skin 12 cm lateral to the midline over the posterior iliac crest, parallel to L3-4 disc space, with 1% xylocaine. He then makes a small skin incision, and then a #22-gauge spinal needle was obliquely passed down in the Codman’s triangle and posterior margin.

At the L3-4 disc space, the needle was easily able to move across and posterior in the disc space, and in the midline; the provider removes 1 cc to 1.5 cc of disc material.

Then, the provider uses a #18-gauge needle to approach the L5-S1 disc space from a superior-posterior angle view, and then passes a #22-gauge Chiba in the disc space. The provider injects dye into the disc space, and there was no communication from the disc space through the posterior margin of the canal, where fragment had been seen on a magnetic resonance imaging (MRI) scan.

Notes indicate that the provider also made and interpreted radiographs.

For this encounter, you’ll report:

• 62287 for the disc decompression.
• 62290 for the injection for discography.
• 72295 for the radiograph creation/interpretation.
• Modifier 59 (Distinct procedural service) appended to 62290 and 72295 to represent the separate natures of the decompression and discography.