How To Use CPT Code 62264

CPT 62264 describes the percutaneous lysis of epidural adhesions using solution injection or mechanical means, including radiologic localization, over multiple sessions on the same day. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 62264?

CPT 62264 can be used to describe the percutaneous lysis of epidural adhesions using solution injection or mechanical means. This procedure involves the provider placing a catheter or introducing a chemical substance to an adhesion in the epidural space to remove the adhesion. It is often referred to as a Racz catheter procedure or epidural neurolysis. The provider uses imaging to identify the site of the adhesions, and the procedure occurs over multiple sessions on the same day.

2. Official Description

The official description of CPT code 62264 is: ‘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; 1 day.’

3. Procedure

1. The provider preps and anesthetizes the patient.
2. Using fluoroscopy, the provider introduces a hollow needle into the epidural space at the appropriate vertebral level.
3. A flexible catheter is passed through the needle and into the epidural space.
4. The provider moves the catheter around the space until reaching the target where the scar tissue is affecting the nerve root.
5. Contrast is injected to confirm the needle tip and catheter location, as well as to evaluate the flow of liquid in the space and any constriction or swelling of the nerve.
6. The provider administers a chemical substance to dissolve the scar tissue and reduce inflammation and irritation on the nerve, or mechanically breaks up the adhesions using the catheter.
7. The procedure may be repeated on the same day as necessary, with repeat epidural contrast injections to verify correct catheter placement and evaluate the surrounding epidural space.
8. Once the injections are complete, the catheter is removed, and a sterile dressing is applied.

4. Qualifying circumstances

CPT 62264 is performed on patients with epidural adhesions that require lysis. Adhesions are fibrous bands that form between tissues and organs, often as a result of injury during surgery. The procedure is suitable for patients who have scar tissue affecting the nerve root in the epidural space. The provider must use imaging to identify the site of the adhesions and evaluate the surrounding epidural space.

5. When to use CPT code 62264

CPT code 62264 should be used when the provider performs percutaneous lysis of epidural adhesions using solution injection or mechanical means over multiple sessions on the same day. It is important to note that CPT code 62264 should not be reported with CPT code 62263.

6. Documentation requirements

To support a claim for CPT code 62264, the provider must document the following information:

• Patient’s diagnosis and the need for percutaneous lysis of epidural adhesions
• Details of the procedure, including the use of solution injection or mechanical means
• Date and duration of each session
• Imaging findings and evaluation of the epidural space
• Substance and amount injected, if applicable
• Progress made during each session
• Signature of the provider performing the procedure

7. Billing guidelines

When billing for CPT code 62264, ensure that the procedure involves percutaneous lysis of epidural adhesions using solution injection or mechanical means over multiple sessions on the same day. It is important not to report CPT code 62264 with CPT code 62263. Additionally, CPT code 62264 includes code 77003, so there is no need to separately report it.

8. Historical information

CPT code 62264 was added to the Current Procedural Terminology system on January 1, 2003. There have been no updates to the code since its addition.

9. Examples

1. A provider performs percutaneous lysis of epidural adhesions using solution injection over multiple sessions on the same day for a patient with chronic back pain.
2. Using mechanical means, a provider performs percutaneous lysis of epidural adhesions over multiple sessions on the same day for a patient with post-surgical scar tissue affecting the nerve root.
3. A provider performs percutaneous lysis of epidural adhesions using solution injection and mechanical means over multiple sessions on the same day for a patient with spinal stenosis.
4. For a patient with failed back surgery syndrome, a provider performs percutaneous lysis of epidural adhesions using solution injection and mechanical means over multiple sessions on the same day.
5. A provider performs percutaneous lysis of epidural adhesions using solution injection and mechanical means over multiple sessions on the same day for a patient with radiculopathy.