Wiki Neuroplasty, lysis of adhesions, or something else

[Talibah]

Greetings all: Our pain doc is all over me about downcoding his procedures. He has asked that we code the report pasted below as 64722. We have gotten several opinions as to how the procedure should be coded and it is returned as 62282 or 62264. Please help. I am at the end of my rope.

PROCEDURES PERFORMED:
1. Needle localization with fluoroscopy.
2. Three-level left-sided lumbar neuroplasty at the level of left L3,left
L4, and left L5.
3. Epidural lysis of adhesions.
4. Lumbar epidural steroid injection with fluoroscopy and epidurogram.

INDICATIONS:
1. Lumbar radiculitis.
2. Epidural fibrosis.

PROCEDURE: All the risks and benefits of the procedures including, but not limited to bleeding, infection, hematoma, and nerve root injury were explained to the patient and the patient asked to proceed. Entered the operating room in stable condition and was placed prone. Cleaned the skin with Betadine x3. Prepped and draped in a usual fashion. A #17-gauge Tuohy needle was inserted into the skin guided by fluoroscopy towards the caudal canal. Epidurogram confirmed placement of the needle tip. Aspiration was negative for blood and CSF. Insertion of epidural catheter to the left L3. Epidurogram confirmed placement of the needle tip. An injection of 1 cc of hypertonic saline followed by 1 cc of lidocaine 0.5% and the catheter was withdrawn to the L4 and L5 and the same procedure was repeated in the same exact fashion at each level. Then, the catheter was withdrawn. An injection of 1 cc of hypertonic saline followed by 15 cc of lidocaine 0.5% with 30 mg of Kenalog was completed. The needle was withdrawn. The patient went to the recovery room in a stable condition with no complications.

Thanks in advance

 

[dwaldman]

64722 lay description
The physician decompresses a nerve. In 64722, the nerve is unspecified. In 64726 the nerve is located at the base of the foot and supplies sensory fibers to one of the toes. The physician makes an incision in the area of nerve tension and locates the nerve. Surrounding soft tissues are dissected from the nerve to release pressure on the nerve.

See the lay description above, this sounds like an orthopedic procedure that requires an incision and I would not use this code. It is in the same section of codes such as Carpal tunnel and ulnar nerve release.

The procedure note you provided sounds like a Lysis of Epidural Adhesions one day. The physician is placing the catheter at separate vertebral levels and releasing the drugs, but I would only bill 62264. It might seem that the reimbursement is low for the amount of work involved, but I think that a lot different things are included within the Lysis procedure and you just have to accept what they paid for it.