Neurosurgery Coding Alert

When it comes to spinal catheters, you must always check the documentation to see if your surgeon placed an indwelling or a tunneled catheter. You must also understand how to correctly report a spinal catheter removal. And, don’t forget to check whether the surgeon used imaging guidance or not.

Read on to learn the steps you can follow to submit clean spinal catheter claims.

Step 1: Turn to These Codes for Indwelling Spinal Catheters

If your neurosurgeon places an indwelling catheter, look to the following codes:

• 62324 (Injection(s), including indwelling catheter placement, continuous infusion or intermittent bolus, of diagnostic or therapeutic substance(s) (eg, anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, interlaminar epidural or subarachnoid, cervical or thoracic; without imaging guidance) and 62325 (… with imaging guidance (ie, fluoroscopy or CT)).
• 62326 (Injection(s), including indwelling catheter placement, continuous infusion or intermittent bolus, of diagnostic or therapeutic substance(s) (eg, anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, interlaminar epidural or subarachnoid, lumbar or sacral (caudal); without imaging guidance) and 62327 (… with imaging guidance (ie, fluoroscopy or CT)).

Don’t miss: You should select the appropriate code from the choices above depending upon the anatomical location of where your surgeon placed the catheter in the spine.

Also, if you look at 62324 and 62325, for example, you will see that the only difference between the descriptors for these codes is that 62325 uses imaging guidance like fluoroscopy or CT. This logic also applies to 62326 and 62327.

Step 2: Check for Laminectomy With Tunneled Approach

If you check the medical documentation and see that your surgeon performed a laminectomy with the implantation, revision, or repositioning of a tunneled intrathecal or epidural catheter, you should report 62351 (Implantation, revision or repositioning of tunneled intrathecal or epidural catheter, for long-term medication administration via an external pump or implantable reservoir/infusion pump; with laminectomy).

On the other hand, if your surgeon did not perform a laminectomy, you will report code 62350 (Implantation, revision or repositioning of tunneled intrathecal or epidural catheter, for long-term medication administration via an external pump or implantable reservoir/infusion pump; without laminectomy).

Don’t miss: Codes 62350 and 62351 apply for the implantation, revision, or repositioning of the spinal catheters for long-term infusion by external or implanted pump. So, you do not need to confirm how your surgeon handled the spinal catheter, other than whether a laminectomy was performed. These two codes also apply to both intrathecal and epidural catheters. You may report them regardless of whether your surgeon placed the catheter in the epidural or intrathecal space.

Step 3: Grasp These Codes for Spinal Catheter Follow-Up Visits

Sometimes, the patient may have to return for a follow-up exam after the implantation of a spinal catheter. In those cases, check out how you would report those follow-up visits for tunneled and non-tunneled spinal catheters.

Tunneled spinal catheter: After the implantation, revision, or repositioning of a tunneled spinal catheter, if the patient needs to return for a follow-up examination of the catheter, you must remember that codes 62350 and 62351 have a global period of 10 days. So, if you read that the patient returned for a follow-up during the global period, you should report 99024 (Postoperative follow-up visit, normally included in the surgical package, to indicate that an evaluation and management service was performed during a postoperative period for a reason[s] related to the original procedure).

Non-tunneled spinal catheter: To report follow-up after a non-tunneled catheter placement, you may check the documentation to confirm the complexity of the problem and how long the evaluation lasted and accordingly report codes 99212 (Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: a problem focused history; a problem focused examination; straightforward medical decision making…) through 99215 (Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: a comprehensive history; a comprehensive examination; medical decision making of high complexity…).

Step 4: Surgeon Removed Spinal Catheter? Do This

When the surgeon removed a previously placed tunneled catheter, you should report 62355 (Removal of previously implanted intrathecal or epidural catheter). Note: This code applies to tunneled spinal catheters for long-term medication administration and not to percutaneously-placed catheters for short term bolus or continuous infusions.

Don’t miss: Like codes 62350 and 62351, code 62355 also applies to both epidural and intrathecal catheters. So, you can report code 62355 for the removal of either an epidural or an intrathecal catheter.

If the surgeon also implanted an internal pump, you must remember to report the removal of that pump, along with the catheter removal. You would report 62365 (Removal of subcutaneous reservoir or pump, previously implanted for intrathecal or epidural infusion) for the pump removal.

Modifier alert: You should also append modifier 58 (Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period) if the removal procedure occurs within the global period of the placement procedure and was prospectively planned to be removed.

Don’t miss: “There are some surgeons who use tunneled spinal catheters with external pumps for managing pain after spinal 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. “However, most insurers consider this incidental to the spinal surgery and therefore not separately reportable.”