TargetCath for lysis of adhesion with caudal injection.


North Andover, MA
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I hope someone can help with this.

We billed 62311 caudal epiduarl steriod injection.
62264 TargetCath eqidural adhesion lysis.
77003 Fluoroscopic needle localization.
OP-notes reads

A skin wheal was raised just superficial and caudal to the sacral hiatus using 1% lidocaine. Then, and 18-gauge Tuohy needle was introduced under direct fluoroscopic guidance and advanced throught the sacral hiatus. The needle was further advanced rostrally and at that point, the C-arm was maneuvered to get an AP view of the pelvis. The needle was visualized midline. Aspiration was negative to blood and or CSF.

At this point, a guidewire was placed through the Tuohy needle and a 5-mm skin incision was made using a scalpel at the point of guidewire to make for easier access for the dilator. The dilator was then theaded through the guidewire and advanced to increase the size of the insertion point at the sacral hiatus. The dilator was removed and the TargetCath was threaded throught the guidewire into the caudal epidural space. Then 8 ml of Isovue 180 was injected and the spread of the dye was noted. The target catheter was manipulated to the left and to the right in an effort to break epidural adhesions. After manipulation of the catheter, the TargetCath tip was more mobile in the epidural space than it was initially, indicating lysis of some of the adhesion.

Then 80 mg of Kenalog mixed with 8 ml of presevative-free 0.5% lidocaine was injected. This was followed by another 8 ml of 0.5% lidocaine. then the catheter was removed.

We billed this to a local MA carrier, and received payment for only 62311.

stating 62264, 77003 included. Is this correct or do we need a modifer?

Any advise will be appreciated.


Jacksonville, FL
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The 77003 is definately included in the 62264, per CPT language, so those 2 codes should not be billed seperately of each other. The 62311 is a column 2 code to the 62264, so if the carrier you billed it uses NCCI edits, then chances are you will not get paid for the other codes.

Sherrie M., CPC