Neurosurgery Coding Alert

Neuroplasty technique smarts are also important for successful claims.

Neuroplasty (also known as epidural neurolysis or epidural adhesiolysis) is a minimally invasive procedure designed to treat chronic pain, particularly in the spine, caused by scar tissue or adhesions.

The procedure involves using a catheter to deliver medication — often including an enzyme, saline, steroid, and local anesthetic — into the epidural space.  This mixture works to break down these adhesions and relieve pressure on nerves.

Read on for a more detailed explanation on what neuroplasty treats and how to report these codes on your claims.

First, Know What Neuroplasty Treats

  Neuroplasty is primarily used to treat chronic back pain, sciatica, and pain associated with failed back surgery syndrome. It specifically targets pain caused by scar tissue (epidural fibrosis) that compresses or irritates nerve roots.

How it is performed: A catheter is inserted into the epidural space, usually via a caudal or transforaminal approach. Fluoroscopic guidance helps visualize the area. The catheter delivers a mixture of medications, including:

• An enzyme to break down scar tissue
• Saline to help distribute the medication
• A steroid to reduce inflammation
• A local anesthetic for pain relief

The enzyme-saline mixture effectively breaks down scar tissue, while the steroid and anesthetic address inflammation and pain. In some cases, a balloon may be used to further create space around the compressed nerves.

For patients who need the procedure, there are many potential benefits to neuroplasty:

• Pain relief: Neuroplasty can significantly relieve pain by reducing pressure on the nerves.

• Improved function: Patients may experience enhanced physical function and mobility as pain and inflammation decrease.

• Minimally invasive: The procedure is minimally invasive, leading to smaller incisions and potentially faster recovery times compared to open surgery.

• May be effective when other treatments fail: Neuroplasty is often considered when conservative treatments, such as physical therapy and medication, have failed to provide adequate pain relief.

Look to This Set for Neuroplasty Codes

Neuroplasty coding involves using CPT^® codes to document surgical procedures involving the exploration, neurolysis, or decompression of nerves. These codes, ranging from 64702 (Neuroplasty; digital, 1 or both, same digit) to +64727 (Internal neurolysis, requiring use of operating microscope (List separately in addition to code for neuroplasty) (Neuroplasty includes external neurolysis)), are found within the CPT^® code set for extracranial nerves, peripheral nerves, and autonomic nervous system, according to AAPC. The correct code selection depends on the specific nerve involved and the type of procedure performed (e.g., exploration, neurolysis, or transposition).

Here are some key aspects of neuroplasty coding:

• Anatomical location: The specific nerve treated is crucial for code selection. For example, codes exist for digital nerves (64702), nerves of the hand or foot (64704), major peripheral nerves in the arm or leg (64708, 64712, 64713, 64714), ulnar nerve at the elbow (64718) or wrist (64719), and median nerve at the carpal tunnel (64721).

• Procedure type: Neuroplasty may consist of exploration, neurolysis (the lysis of adhesions or scar tissue), or transposition (repositioning the nerve). According to an article by the National Center for Biotechnology Information (NCBI) discussing the newer approaches to neuroplastic treatments, conventional neuroplasty can be further categorized into chemical adhesiolysis using hypertonic saline or mechanical adhesiolysis using a laterally movable catheter.

As mentioned above, some updated treatments being introduced, such as the Racz procedure or epidural neurolysis, can involve percutaneous epidural balloons, which involve breaking down scar tissue in the epidural space of the spine. This procedure utilizes a catheter with a balloon at the tip to disrupt adhesions and deliver substances like hypertonic saline and corticosteroids.

When coding, it is important to consider whether the procedure involves multiple sessions and the duration of these sessions. Follow these coding rules for multiple sessions:

• If the procedure involves multiple sessions over two or more days, report 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).

• If multiple sessions are conducted within a single day, use 62264 (… 1 day).

Both codes include fluoroscopy and CT guidance, which should not be reported separately.

Mind These Tips and Tricks for Neuroplasty Coding

When coding for your surgeon’s neuroplasty services, there are a few insider tips you should memorize in order to expedite your claim. First, know that neuroplasty procedures can be performed using either an open surgical approach or an endoscopic method.

As new procedures for neuroplasty emerge, it may be necessary to use 64999 (Unlisted procedure, nervous system) alongside the neuroplasty code if a nerve is wrapped with materials like NeruraWrap.

When filing your neuroplasty claims, here are a few final thoughts and considerations:

• One line or two? Some payers may require modifier 50 (Bilateral procedure) to be appended to the CPT^® code when the procedure is performed bilaterally.

• Same-day procedure? When neuroplasty is performed alongside another procedure, such as a tendon repair, it is crucial to ensure that proper coding and billing practices are followed to avoid potential denials.

• Check in with your payers. Always verify coding and billing guidelines with individual payers, as they may have specific requirements or policies.

• Monitor your MUE counts! Medically unlikely edits (MUEs) are guidelines issued by the Centers for Medicare & Medicaid Services (CMS). They define the maximum number of service units that are likely to be reported for a single beneficiary on a single date of service. Just like coding for any other surgery, you need to make sure that your neuroplasty coding takes MUEs into account.

Jessica Sullivan, CPC, COBGC, COSC, Consultant,
Pinnacle Enterprise Risk Consulting Services