Orthopedic Coding Alert

Choose the correct lysis codes based on the number of procedural days If you're billing your orthopedist's spinal adhesion surgeries based on the number of lesions he lyses, you could be forfeiting as much as $250 per procedure, based on Medicare's nonfacility reimbursement rates. CPT directs coders to report 62263 for two or more days of lysis surgery, while you should use 62264 if the surgeon finishes the procedure in a single day.

During epidural lysis of spinal adhesions - also called the Racz catheter procedure or epidural adhesiolysis - the orthopedic surgeon inserts a needle near the patient's tailbone to inject dye, and then threads a catheter through the needle to inject medication into the patient's adhesions.

The orthopedist removes the needle after the procedure but can leave the catheter in place for up to three days to continue treating the lesions.

The following codes apply to Racz procedures:

62263 -- Percutaneous lysis of epidural adhesions using solution injection [e.g., hypertonic saline, enzyme] or mechanical means [e.g., catheter] including adiologic localization [includes contrast when administered], multiple adhesiolysis sessions; 2 or more days

62264 -- ... 1 day Report Just 1 Unit Per Day Wrong way: Despite the fact that CPT assigns 62263 to a procedure of two or more days and 62264 to a one-day procedure, some coders still try to report additional units each time physicians perform additional injections.

"One of our surgeons sometimes writes '62263 x 3 injections' on the chart," says Debbie Oldfield, biller at Spine Associates LLC, a four-physician practice in Jackson, Miss. "I know not to put more than one unit of 62263 on the claim, but it would be easy for a new coder to try to bill three units, which is wrong."

Right way: "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.

And don't even try to submit one unit of 62263 with one unit of 62264 to reflect three days' worth of lysis. The National Correct Coding Initiative (NCCI) considers 62264 a component of 62263, so Medicare and most other carriers will immediately deny 62264 if you report these codes together. Don't Report Fluoroscopy Separately Remember: You should never separately report fluoroscopy or epidurography when you bill 62263 or 62264. "These two codes specifically state that you cannot bill separately for fluoroscopy," says Annette Grady, CPC, CPC-H, senior healthcare consultant at Eide Bailly LLP in Bismarck, N.D., and chair of the North American Spine Society's administrative task force.

A parenthetical in CPT states that 62263 and 62264 include the services represented by 76005 (Fluoroscopic guidance and localization of needle or catheter tip for spine or paraspinous diagnostic [...]