Neurosurgery Coding Alert

Hint: Never report codes 62263 and 62264 together.

If your neurosurgeon performs percutaneous epidural adhesiolysis (PEA) to treat scarring in a patient’s spinal canal, you must look for numerous details in the documentation including the number of treatment days for the adhesiolysis.

Read on to learn more.

Tip 1: First, Define Adhesiolysis for Clarity

If scarring (also known as adhesions) “forms around the nerves in a patient’s spinal canal, these nerves can become fixed into one position and cause significant swelling in the nerve root,” according to CPT^® Assistant Vol. 22, No. 6. These adhesions can cause radiating pain for patients.

Adhesiolysis, the lysis of adhesions, also known as epidural neuroplasty or epidural neurolysis, occurs when your neurosurgeon breaks up the adhesions to lessen the effects scar tissue may cause in the spinal canal and may allow medications such as steroids to get to the affected areas and help alleviate the pain.

“The treatment goal [of adhesiolysis] is to break down scar formation (adhesions), reduce edema, reduce inflammation, and block propagation of nociception (pain transmission) to the central nervous system,” per CPT^® Assistant.

“Several systematic reviews have examined the published evidence regarding the safety and efficacy of percutaneous and endoscopic adhesiolysis in the treatment of back and leg pain after prior lumbar surgery,” says Gregory Przybylski, MD, immediate past chairman of neuroscience and director of neurosurgery at the New Jersey Neuroscience Institute, JFK Medical Center in Edison, New Jersey. “While small sample sizes and limited well-designed studies have been cited as limitations, authors of these systematic reviews have concluded there is fair evidence of short and long-term improvement in pain and function after these treatments overall. The role and additional effectiveness of the various injected solutions that are used is less clear.”

Tip 2: Turn to These 2 Codes for Adhesiolysis

If your neurosurgeon places a catheter or introduces a chemical substance to an adhesion in the epidural space to remove the adhesion, you should report the following CPT^® codes:

• 62263 (Percutaneous lysis of epidural adhesions using solution injection (eg, hypertonic saline, enzyme) or mechanical means (eg, catheter) including radiologic localization (includes contrast when administered), multiple adhesiolysis sessions; 2 or more days)
• 62264 (… 1 day).

Don’t miss: When your neurosurgeon performs adhesiolysis, you may see the terms “Racz catheter” or “NaviCath” in the medical documentation. You should report either 62263 or 62264 for these procedures, depending upon the number of treatment days.

Racz catheter procedure defined: A Racz catheter procedure is an invasive method commonly adopted for attempting to relieve pain. In this procedure, your neurosurgeon will place a wire catheter through the tailbone and advance it into the caudal canal and the lumbar epidural space. Your neurosurgeon will then infuse an enzyme called hyaluronidase to break down the scar tissue. Your neurosurgeon will also infuse hypertonic saline through the catheter to provide relief from pain and facilitate dissolution of the adhesions. Following this, your neurosurgeon may use steroids.

NaviCath system defined: A NaviCath system is a semi-rigid, flexible, and steerable plastic catheter that uses a semi-rigid Teflon-coated wire wound catheter. Since a NaviCath is stiffer than a Racz catheter, surgeons usually use it to break up denser epidural scars.

Tip 3: Know How Often to Report 62263 and 62264

You must pay attention to how often you can report codes 62263 and 62264 because CPT^® has strict rules for this.

You should report both codes 62263 and 62264 “only one time for the entire series of injections, infusions, or mechanical lysis procedures performed, not per adhesiolysis treatment,” according to CPT^® Assistant.

Don’t miss: You should never report codes 62263 and 62264 together. Since 62263 and 62264 are mutually exclusive, you should report only one of these codes on your claim.

Bottom line: When it comes to codes 62263 and 62264, you should count the days and not the adhesions. Code 62264 describes multiple adhesiolysis treatment sessions your neurosurgeon performs on the same day. The treatment for code 62263 will span two or more treatment days.

Coding example: The neurosurgeon performed an epidural lysis of adhesions using hypertonic saline. The neurosurgeon administered four injections during one day. You

should report 62264 on your claim since the treatment lasted just one day. Remember, you will only report 62264 once, even though the neurosurgeon performed multiple injections.