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Coding guidelines for Intervertebral Disc Aspiration


Intervertebral disc aspiration involves placement of a needle into the disc space with aspiration, and washings, in an attempt to gain enough sample to evaluate for the possibility of disc infection.

CPT 62267 - Percutaneous aspiration within the nucleus pulposus, intervertebral disc, or paravertebral tissue for diagnostic purposes.

For imaging, use 77003 - Fluoroscopic guidance and localization of needle or catheter tip for spine or paraspinous diagnostic or therapeutic injection procedures (epidural or subarachnoid).

Procedure Description:

The physician positions the patient on his side or lying face down and after prepping and draping the patient, administers a local anesthetic at the proposed puncture site. Using fluoroscopy or computed tomography imaging guidance, the physician then introduces a hollow needle into the spinal column at the puncture site. then advances the needle until she positions it in the disc or in the surrounding tissue. Then he verifies the needle placement using CT or fluoroscopic imaging then uses the needle to aspirate fluid and or cells, moving the needle and taking samples as necessary. he sends samples to the laboratory for diagnostic testing. Finally, he withdraws the needle and applies a sterile dressing.

CPT 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 the use of an endoscope, with discography and/or epidural injections at the treated levels, when performed, single or multiple levels, lumbar

Procedure Description:

Patient is appropriately prepped and anesthetized, the physician uses one of several methods to decompress or remove disc material from a disc that is protruding through two or more vertebrae in the lumbar portion of the spine. In any method, using fluoroscopy, the physician injects contrast into the gel like center, or nucleus, of the suspect spinal disc to better visualize the disc and protruding material, known as discography. The physician also uses an endoscope and fluoroscopy guidance, along with a local epidural anesthetic injection, to perform a lumbar decompression. In this procedure, the physician places the patient on a radiolucent table and inserts a needle through a stab wound in the flank, or side of the patient and guides the needle into the disc interspace, being careful not to puncture the dura. After puncturing the disc, he confirms the proper positioning of the needle using fluoroscopic images. Next, he either manually, or using an automated device, radiofrequency, or laser energy, aspirates disc tissue, removing as much material as he safely can until he decompresses the nerve.

Note:

If deep bone biopsy of the vertebral body end plate and percutaneous disc aspiration are performed at the same level, use code 20225 to describe the procedure. Do not use code 62267 in this case.

Do not use code 62267 with codes for Fine needle aspiration (10022), deep bone biopsy (20225), therapeutic disc decompression (62287), or discography (62290, 62291).

Use code 62287 when the physician is performing a therapeutic removal of disc material percutaneously to ease symptoms of disc compression of adjacent nerves. Code 62287 is used only once, regardless of the number of levels treated at one session.

Do not report 62287 in conjunction with 62267, 62290, 62311, 77003, 77012, 72295, when performed at same level.

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