Neurosurgery Coding Alert

Question: According to the op report, the neurosurgeon removed a small amount of gel-like substance in the middle of a spinal disc, known as nucleus pulposus. He made a needle puncture through the skin and into the disc. Then he aspirated a small amount of disc material between two vertebrae in the lumbar region of the spine to relieve pressure on the nerves of the spine. Which CPT^® code should I report for this procedure?

California Subscriber

Answer: You should 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 this decompression procedure.

Caution: You should never report 62287 in conjunction with the following codes, when performed at the same level, according to the CPT^® guidelines:

• 62267 (Percutaneous aspiration within the nucleus pulposus, intervertebral disc, or paravertebral tissue for diagnostic purposes)
• 62290 (Injection procedure for discography, each level; lumbar)
• 62322 (Injection(s), of diagnostic or therapeutic substance(s) (eg, anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, including needle or catheter placement, interlaminar epidural or subarachnoid, lumbar or sacral (caudal); without imaging guidance)
• +77003 (Fluoroscopic guidance and localization of needle or catheter tip for spine or paraspinous diagnostic or therapeutic injection procedures (epidural or subarachnoid) (List separately in addition to code for primary procedure))
• 77012 (Computed tomography guidance for needle placement (eg, biopsy, aspiration, injection, localization device), radiological supervision and interpretation)
• 72295 (Discography, lumbar, radiological supervision and interpretation)

Don’t miss: For non-needle based technique for percutaneous decompression of the spinal canal (typically without removal of the nucleus pulposus of the intervertebral disc, though it would be included if performed), you would look to codes 0274T (Percutaneous laminotomy/laminectomy (interlaminar approach) for decompression of neural elements, (with or without ligamentous resection, discectomy, facetectomy and/or foraminotomy), any method, under indirect image guidance (eg, fluoroscopic, CT), single or multiple levels, unilateral or bilateral; cervical or thoracic) or 0275T (… lumbar), instead, per the CPT^® guidelines.