This info listed to assist Dr. W. for coding procedures.
NEUROSPINE: Spine and Spinal Cord (62263-63746) and INJECTIONS
(For application of caliper or tongs, use 20660)
(For treatment of fracture or dislocation of spine, see 22305 22310 22315 22318 22319 22325 22326 -22327)
Navigation (acc to Will Kilpatrick 11/13)
61783 Stereotactic computer assisted volumetric (navigational) procedure, spinal (and also 0055T)
Injection, Drainage, or Aspiration (62263-62319)
62270 Spinal puncture, lumbar, diagnostic
62272 Spinal puncture, therapeutic, for drainage of cerebrospinal fluid (by needle or catheter)
62273 Injection, epidural, of blood or clot patch
62278 (CA Work Comp code) lumbar epidural injection, single, per Margaret Gross (2/06), doesn’t specify interlam vs transforam
62287 Aspiration or decompression procedure, percutaneous, of nucleus pulposus of intervertebral disk, any method, single or multiple levels, lumbar (eg, manual or automated percutaneous diskectomy, percutaneous laser diskectomy)
(For fluoroscopic guidance, use 76003) (as of 2012, cannot be billed with codes 62267, 62290, 62311 or imaging codes 77003, 77012 or 72295, when performed at the same level)
62290 Injection procedure for diskography, each level; lumbar
62291 Injection procedure for diskography, each level; cervical or thoracic
(For radiological supervision and interpretation, see 72285, 72295)
62292 Injection procedure for chemonucleolysis, including diskography, intervertebral disk, single or multiple levels, lumbar
62310 Injection, single (not via indwelling catheter), not including neurolytic substances, with or without contrast (for either localization or epidurography), of diagnostic or therapeutic substance(s) (including anesthetic, antispasmodic, opioid, steroid, other solution), epidural or subarachnoid; cervical or thoracic
New codes as of 1/1/17:
CPT CODE 62311 HAS BEEN DELETED – WILL NEED TO CHOOSE FROM ONE OF THE FOLLOWING:
62320 – 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, cervical or thoracic; without imaging guidance
62321 – 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, cervical or thoracic; with imaging guidance – fluoroscopy or CT
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
62323 – 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) with imaging guidance (i.e. fluoroscopy or CT)
(as of 2011, fluoro and contrast injection also bundled in. Also, per conversation 4/8/14 with Jennifer who does billing for Dr. Moree, this code is used for a caudal nerve block. Per internet search, a code for coccygeal nerve block is 64450)
For transforaminal epidural injection, see 64479 64480 (cerv/thoracic and addit level) 64483 (lumbar single level), 64484 (lumbar addit level, as of 2011, fluoro 77003 bundled in with these codes)
(for facet joints, see below, 64475,6)
Toradol injection: J1885 for medication, for each 15 mg, with usual dose given 30 mg (and include with trigger point injection code)
Catheter Implantation (62350-62355)
(For percutaneous placement of intrathecal or epidural catheter, see codes 62270 62272 -62273, 62280 62281 62282 -62284, 62310 62311 62318 -62319)
62350 Implantation, revision or repositioning of tunneled intrathecal or epidural catheter, for long-term medication administration via an external pump or implantable reservoir/infusion pump; without laminectomy
62351 Implantation, revision or repositioning of tunneled intrathecal or epidural catheter, for long-term medication administration via an external pump or implantable reservoir/infusion pump; with laminectomy
(For refilling and maintenance of an implantable infusion pump for spinal or brain drug therapy, use 95990)
62355 Removal of previously implanted intrathecal or epidural catheter
Reservoir/Pump Implantation (62360-62368)
62360 Implantation or replacement of device for intrathecal or epidural drug infusion; subcutaneous reservoir
62361 Implantation or replacement of device for intrathecal or epidural drug infusion; non-programmable pump
62362 Implantation or replacement of device for intrathecal or epidural drug infusion; programmable pump, including preparation of pump, with or without programming
62365 Removal of subcutaneous reservoir or pump, previously implanted for intrathecal or epidural infusion
(For refilling and maintenance of an implantable infusion pump for spinal or brain drug therapy, use 95990)
Posterior Extradural Laminotomy or Laminectomy for Exploration/Decompression of Neural Elements or Excision of Herniated Intervertebral Disks (63001-63048)
(When 63001- 63048 are followed by arthrodesis, see 22590 22595 22600 22610 22612 -22614)
63001 Laminectomy with exploration and/or decompression of spinal cord and/or cauda equina, without facetectomy, foraminotomy or diskectomy, (eg, spinal stenosis), one or two vertebral segments; cervical
63003 Laminectomy with exploration and/or decompression of spinal cord and/or cauda equina, without facetectomy, foraminotomy or diskectomy, (eg, spinal stenosis), one or two vertebral segments; thoracic
63005 Laminectomy with exploration and/or decompression of spinal cord and/or cauda equina, without facetectomy, foraminotomy or diskectomy, (eg, spinal stenosis), one or two vertebral segments; lumbar, except for spondylolisthesis
63011 Laminectomy with exploration and/or decompression of spinal cord and/or cauda equina, without facetectomy, foraminotomy or diskectomy, (eg, spinal stenosis), one or two vertebral segments; sacral
63012 Laminectomy with removal of abnormal facets and/or pars inter-articularis with decompression of cauda equina and nerve roots for spondylolisthesis, lumbar (Gill type procedure)
63015 Laminectomy with exploration and/or decompression of spinal cord and/or cauda equina, without facetectomy, foraminotomy or diskectomy, (eg, spinal stenosis), more than 2 vertebral segments; cervical
63016 Laminectomy with exploration and/or decompression of spinal cord and/or cauda equina, without facetectomy, foraminotomy or diskectomy, (eg, spinal stenosis), more than 2 vertebral segments; thoracic
63017 Laminectomy with exploration and/or decompression of spinal cord and/or cauda equina, without facetectomy, foraminotomy or diskectomy, (eg, spinal stenosis), more than 2 vertebral segments; lumbar
63020 Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disk; one interspace, cervical (as of 2012, excludes endoscopically assisted approach)
63030 Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disk; one interspace, lumbar (including open or endoscopically-assisted approach, as of 2012, excludes endoscopically assisted approach)
63035 Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disk; each additional interspace, cervical or lumbar (List separately in addition to code for primary procedure)
(Use 63035 in conjunction with codes 63020 -63030)
(63020, 63030, 63035 are unilateral procedures. For bilateral procedures, use modifier ‘-50’)
63040 Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disk, reexploration, single interspace; cervical
63042 Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disk, reexploration, single interspace; lumbar
(Codes 63040, 63042 are unilateral procedures. For bilateral procedures, use modifier ‘-50’)
63043 Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disk, reexploration, single interspace; each additional cervical interspace (List separately in addition to code for primary procedure)
63044 Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disk, reexploration, single interspace; each additional lumbar interspace (List separately in addition to code for primary procedure)
63045 Laminectomy, facetectomy and foraminotomy (unilateral or bilateral with decompression of spinal cord, cauda equina and/or nerve root(s), (eg, spinal or lateral recess stenosis)), single vertebral segment; cervical
63046 Laminectomy, facetectomy and foraminotomy (unilateral or bilateral with decompression of spinal cord, cauda equina and/or nerve root(s), (eg, spinal or lateral recess stenosis)), single vertebral segment; thoracic
63047 Laminectomy, facetectomy and foraminotomy (unilateral or bilateral with decompression of spinal cord, cauda equina and/or nerve root(s), (eg, spinal or lateral recess stenosis)), single vertebral segment; lumbar
63048 Laminectomy, facetectomy and foraminotomy (unilateral or bilateral with decompression of spinal cord, cauda equina and/or nerve root(s), (eg, spinal or lateral recess stenosis)), single vertebral segment; each additional segment, cervical, thoracic, or lumbar (List separately in addition to code for primary procedure)
(acc to Dr. Reynolds, 10/04: there is no code for re-explor laminect, must use lam code 63047, Also, this code, 63047, is bundled with 22630 for a PLIF, and you do a decomp of the spinal nerve roots. Unbundle by using modifier -59 and document in your op rept the decompression in detail.)
(Use 63048 in conjunction with codes 63045 63046 -63047)
63050 Laminoplasty, cerv, with decompression of the spinal cord, two or more vertebral segments.
63051 with reconstruction of the posterior bony elements, including the application of bridging bone graft and non-segmental fixation devices, eg., wire, suture, mini–plates, when performed.
Transpedicular or Costovertebral Approach for Posterolateral Extradural Exploration/Decompression (63055-63066)
63055 Transpedicular approach with decompression of spinal cord, equina and/or nerve root(s) (eg, herniated intervertebral disk), single segment; thoracic
63056 Transpedicular approach with decompression of spinal cord, equina and/or nerve root(s) (eg, herniated intervertebral disk), single segment; lumbar (including transfacet, or lateral extraforaminal approach) (eg, far lateral herniated intervertebral disk)
63057 Transpedicular approach with decompression of spinal cord, equina and/or nerve root(s) (eg, herniated intervertebral disk), single segment; each additional segment, thoracic or lumbar (List separately in addition to code for primary procedure)
(Use 63057 in conjunction with codes 63055, 63056)
63064 Costovertebral approach with decompression of spinal cord or nerve root(s), (eg, herniated intervertebral disk), thoracic; single segment
63066 Costovertebral approach with decompression of spinal cord or nerve root(s), (eg, herniated intervertebral disk), thoracic; each additional segment (List separately in addition to code for primary procedure)
(Use 63066 in conjunction with code 63064)
(For excision of thoracic intraspinal lesions by laminectomy, see 63266, 63271, 63276, 63281, 63286)
Anterior or Anterolateral Approach for Extradural Exploration/Decompression (63075-63091)
For the following codes, when two surgeons work together as primary surgeons performing distinct part(s) of spinal cord exploration/decompression operation, each surgeon should report his/her distinct operative work by appending the modifier ‘-62’ to the procedure code (and any associated add-on codes for that procedure code as long as both surgeons continue to work together as primary surgeons). In this situation, the modifier ‘-62’ may be appended to the definitive procedure code(s) 63075, 63077, 63081, 63085, 63087, 63090 and, as appropriate, to associated additional interspace add-on code(s) 63076, 63078 or additional segment add-on code(s) 63082, 63086, 63088, 63091 as long as both surgeons continue to work together as primary surgeons.
63075 Diskectomy, anterior, with decompression of spinal cord and/or nerve root(s), including osteophytectomy; cervical, single interspace
63076 Diskectomy, anterior, with decompression of spinal cord and/or nerve root(s), including osteophytectomy; cervical, each additional interspace (List separately in addition to code for primary procedure)
Effective 1/1/11:
Most significantly, there are new combined codes for anterior cervical discectomy and fusion (ACDF) that should be used instead of codes 63075 and 22554:
22551: Arthrodesis, anterior interbody, including disc space preparation, discectomy, osteophytectomy and decompression of spinal cord and/or nerve roots, cervical, below C2
22552: cervical below C2, each additional interspace (List separately in addition to code for separate procedure)
(Use 63076 in conjunction with code 63075)
63077 Diskectomy, anterior, with decompression of spinal cord and/or nerve root(s), including osteophytectomy; thoracic, single interspace
63078 Diskectomy, anterior, with decompression of spinal cord and/or nerve root(s), including osteophytectomy; thoracic, each additional interspace (List separately in addition to code for primary procedure)
(acc to Dr. Reynolds, 10/04: 63075 is mainly used for coding the decompression. The op report must clearly document the decompressing of the nerve roots and or spinal cord in order for the insurance to pay. The insurance is looking for clear documentation, such as: opening the PLL or removing far lat disc fragments to decomp nerve roots)
(Use 63078 in conjunction with code 63077)
(Do not report code 69990 in addition to codes 63075 63076 63077 -63078)
63081 Vertebral corpectomy (vertebral body resection), partial or complete, anterior approach with decompression of spinal cord and/or nerve root(s); cervical, single segment
63082 Vertebral corpectomy (vertebral body resection), partial or complete, anterior approach with decompression of spinal cord and/or nerve root(s); cervical, each additional segment (List separately in addition to code for primary procedure)
(Use 63082 in conjunction with code 63081)
(For transoral approach, see 61575, 61576)
63085 Vertebral corpectomy (vertebral body resection), partial or complete, transthoracic approach with decompression of spinal cord and/or nerve root(s); thoracic, single segment
63086 Vertebral corpectomy (vertebral body resection), partial or complete, transthoracic approach with decompression of spinal cord and/or nerve root(s); thoracic, each additional segment (List separately in addition to code for primary procedure)
(Use 63086 in conjunction with code 63085)
63087 Vertebral corpectomy (vertebral body resection), partial or complete, combined thoracolumbar approach with decompression of spinal cord, cauda equina or nerve root(s), lower thoracic or lumbar; single segment
63088 Vertebral corpectomy (vertebral body resection), partial or complete, combined thoracolumbar approach with decompression of spinal cord, cauda equina or nerve root(s), lower thoracic or lumbar; each additional segment (List separately in addition to code for primary procedure)
(Use 63088 in conjunction with code 63087)
63090 Vertebral corpectomy (vertebral body resection), partial or complete, transperitoneal or retroperitoneal approach with decompression of spinal cord, cauda equina or nerve root(s), lower thoracic, lumbar, or sacral; single segment
63091 Vertebral corpectomy (vertebral body resection), partial or complete, transperitoneal or retroperitoneal approach with decompression of spinal cord, cauda equina or nerve root(s), lower thoracic, lumbar, or sacral; each additional segment (List separately in addition to code for primary procedure)
(Use 63091 in conjunction with code 63090)
(Procedures 63081 63082 63085 63086 63087 63088 63090 -63091 include diskectomy above and/or below vertebral segment)
(If followed by arthrodesis, see 22548 22554 22556 22558 22585 22590 22595 22600 22610 22612 22614 22630 22632 22800 22802 22804 22808 22810 -22812)
(For reconstruction of spine, use appropriate vertebral corpectomy codes 63081 63082 63085 63086 63087 63088 63090 -63091, bone graft codes 20930 20931 20936 20937 -20938, arthrodesis codes 22548 22554 22556 22558 22585 22590 22595 22600 22610 22612 22614 22630 22632 22800 22802 22804 22808 22810 -22812 and spinal instrumentation codes 22840 22841 22842 22843 22844 22845 22846 22847 22848 22849 22850 22851 22852 -22855)
Lateral Extracavitary Approach for Extradural Exploration/Decompression (63101-63103)
63101 Vertebral corpectomy (vertebral body resection), partial or complete, lateral extracavitary approach with decompression of spinal cord and/or nerve root(s) (eg, for tumor or retropulsed bone fragments); thoracic, single segment
63102 Vertebral corpectomy (vertebral body resection), partial or complete, lateral extracavitary approach with decompression of spinal cord and/or nerve root(s) (eg, for tumor or retropulsed bone fragments); lumbar, single segment
63103 Vertebral corpectomy (vertebral body resection), partial or complete, lateral extracavitary approach with decompression of spinal cord and/or nerve root(s) (eg, for tumor or retropulsed bone fragments); thoracic or lumbar, each additional segment (List separately in addition to code for primary procedure)
(Use 63103 in conjunction with 63101 and 63102)
Incision (63170-63200)
63194 Laminectomy with cordotomy, with section of one spinothalamic tract, one stage; cervical
63195 Laminectomy with cordotomy, with section of one spinothalamic tract, one stage; thoracic
63196 Laminectomy with cordotomy, with section of both spinothalamic tracts, one stage; cervical
63197 Laminectomy with cordotomy, with section of both spinothalamic tracts, one stage; thoracic
63198 Laminectomy with cordotomy with section of both spinothalamic tracts, two stages within 14 days; cervical
63199 Laminectomy with cordotomy with section of both spinothalamic tracts, two stages within 14 days; thoracic
63200 Laminectomy, with release of tethered spinal cord, lumbar
Excision by Laminectomy of Lesion Other Than Herniated Disk (63250-63290)
63250 Laminectomy for excision or occlusion of arteriovenous malformation of spinal cord; cervical
63251 Laminectomy for excision or occlusion of arteriovenous malformation of spinal cord; thoracic
63252 Laminectomy for excision or occlusion of arteriovenous malformation of spinal cord; thoracolumbar
63265 Laminectomy for excision or evacuation of intraspinal lesion other than neoplasm, extradural; cervical
63266 Laminectomy for excision or evacuation of intraspinal lesion other than neoplasm, extradural; thoracic
63267 Laminectomy for excision or evacuation of intraspinal lesion other than neoplasm, extradural; lumbar
63268 Laminectomy for excision or evacuation of intraspinal lesion other than neoplasm, extradural; sacral
63270 Laminectomy for excision of intraspinal lesion other than neoplasm, intradural; cervical
63271 Laminectomy for excision of intraspinal lesion other than neoplasm, intradural; thoracic
63272 Laminectomy for excision of intraspinal lesion other than neoplasm, intradural; lumbar
63273 Laminectomy for excision of intraspinal lesion other than neoplasm, intradural; sacral
63275 Laminectomy for biopsy/excision of intraspinal neoplasm; extradural, cervical
63276 Laminectomy for biopsy/excision of intraspinal neoplasm; extradural, thoracic
63277 Laminectomy for biopsy/excision of intraspinal neoplasm; extradural, lumbar
63278 Laminectomy for biopsy/excision of intraspinal neoplasm; extradural, sacral
63280 Laminectomy for biopsy/excision of intraspinal neoplasm; intradural, extramedullary, cervical
63281 Laminectomy for biopsy/excision of intraspinal neoplasm; intradural, extramedullary, thoracic
63282 Laminectomy for biopsy/excision of intraspinal neoplasm; intradural, extramedullary, lumbar
63283 Laminectomy for biopsy/excision of intraspinal neoplasm; intradural, sacral
63285 Laminectomy for biopsy/excision of intraspinal neoplasm; intradural, intramedullary, cervical
63286 Laminectomy for biopsy/excision of intraspinal neoplasm; intradural, intramedullary, thoracic
63287 Laminectomy for biopsy/excision of intraspinal neoplasm; intradural, intramedullary, thoracolumbar
63290 Laminectomy for biopsy/excision of intraspinal neoplasm; combined extradural-intradural lesion, any level
(For drainage of intramedullary cyst/syrinx, use 63172, 63173)
Excision, Anterior or Anterolateral Approach, Intraspinal Lesion (63300-63308)
For the following codes, when two surgeons work together as primary surgeons performing distinct part(s) of an anterior approach for an intraspinal excision, each surgeon should report his/her distinct operative work by appending the modifier ‘-62’ to the single definitive procedure code. In this situation, the modifier ‘-62’ may be appended to the definitive procedure code(s) 63300-63307 and, as appropriate, to the associated additional segment add-on code 63308 as long as both surgeons continue to work together as primary surgeons.
(For arthrodesis, see 22548 22554 22556 22558 -22585)
(For reconstruction of spine, see 20930 20931 20936 20937 -20938)
63300 Vertebral corpectomy (vertebral body resection), partial or complete, for excision of intraspinal lesion, single segment; extradural, cervical
63301 Vertebral corpectomy (vertebral body resection), partial or complete, for excision of intraspinal lesion, single segment; extradural, thoracic by transthoracic approach
63302 Vertebral corpectomy (vertebral body resection), partial or complete, for excision of intraspinal lesion, single segment; extradural, thoracic by thoracolumbar approach
63303 Vertebral corpectomy (vertebral body resection), partial or complete, for excision of intraspinal lesion, single segment; extradural, lumbar or sacral by transperitoneal or retroperitoneal approach
63304 Vertebral corpectomy (vertebral body resection), partial or complete, for excision of intraspinal lesion, single segment; intradural, cervical
63305 Vertebral corpectomy (vertebral body resection), partial or complete, for excision of intraspinal lesion, single segment; intradural, thoracic by transthoracic approach
63306 Vertebral corpectomy (vertebral body resection), partial or complete, for excision of intraspinal lesion, single segment; intradural, thoracic by thoracolumbar approach
63307 Vertebral corpectomy (vertebral body resection), partial or complete, for excision of intraspinal lesion, single segment; intradural, lumbar or sacral by transperitoneal or retroperitoneal approach
63308 Vertebral corpectomy (vertebral body resection), partial or complete, for excision of intraspinal lesion, single segment; each additional segment (List separately in addition to codes for single segment)
(Use 63308 in conjunction with codes 63300 63301 63302 63303 63304 63305 63306 -63307)
63610 Stereotactic stimulation of spinal cord, percutaneous, separate procedure not followed by other surgery
63615 Stereotactic biopsy, aspiration, or excision of lesion, spinal cord
Neurostimulators (Spinal) (63650-63688)
Codes 63650 63655 63660 63685 -63688 apply to both simple and complex neurostimulators. For initial or subsequent electronic analysis and programming of neurostimulator pulse generators, see codes 95970 95971 95972 95973 95974 -95975.
Codes 63650, 63655, and 63660 describe the operative placement, revision, or removal of the spinal neurostimulator system components to provide spinal electrical stimulation. A neurostimulator system includes an implanted neurostimulator, external controller, extension, and collection of contacts. Multiple contacts or electrodes (4 or more) provide the actual electrical stimulation in the epidural space.
For percutaneously placed neurostimulator systems (63650, 63660), the contacts are on a catheter-like lead. An array defines the collection of contacts that are on one catheter.
For systems placed via an open surgical exposure (63655, 63660), the contacts are on a plate or paddle-shaped surface.
SPINAL STIMS (use dx codes 722.83 (post laminect syndr lumbar) and 722.73 (lumbar myelop, 2ndary code))
63650 Percutaneous implantation of neurostimulator electrode array, epidural
(programming is 95972)
63655 Laminectomy for implantation of neurostimulator electrodes, plate/paddle, epidural
(no longer valid after 2010: 63660 Revision or removal of spinal neurostimulator electrode percutaneous array(s) or plate/paddle(s), instead see 63661-4)
63661 Removal of spinal neurostimulator electrode percutaneous array(s) including fluoroscopy, when performed
63662 Removal of spinal neurostimulator electrode paddle/paddle(s) placed via laminotomy or laminectomy, including fluoroscopy, when performed
63663 Revision including replacement, when performed. of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed (do not report 63663 in conjunction with 63661, 63662 for the same spinal level)
63664 Revision including replacement, when performed, of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy, including fluoroscopy, when performed
63685 Incision and subcutaneous placement of spinal neurostimulator pulse generator or receiver, direct or inductive coupling
63688 Revision or removal of implanted spinal neurostimulator pulse generator or receiver
Repair (63700-63710)
63700 Repair of meningocele; less than 5 cm diameter
63702 Repair of meningocele; larger than 5 cm diameter
(Do not use modifier ‘-63’ in conjunction with 63700, 63702)
63704 Repair of myelomeningocele; less than 5 cm diameter
63706 Repair of myelomeningocele; larger than 5 cm diameter
(Do not use modifier ‘-63’ in conjunction with 63704, 63706)
(For complex skin closure, see Integumentary System)
63707 Repair of dural/cerebrospinal fluid leak, not requiring laminectomy
63709 Repair of dural/cerebrospinal fluid leak or pseudomeningocele, with laminectomy
63710 Dural graft, spinal
(For laminectomy and section of dentate ligaments, with or without dural graft, cervical, see 63180, 63182)
Introduction/Injection of Anesthetic Agent (Nerve Block), Diagnostic or Therapeutic
64483 Injection, anesthetic agent and/or steroid, transforaminal epidural, (TESI) lumbar or sacral, single level
64484 each additional level, lumbar or sacral
64520 Coccygeal Nerve Block (per Wendy H., May ’14, Medicare pays about $370)
Excision
64774 Excision of neuroma; cutaneous nerve, surgically identifiable
Facet injection
A routine audit is in place for claims for CPT 64470 – 64475. These codes for paravertebral facet joint injections will deny if:
Medial Branch Block/Paravertebral Facet Joint Nerve Block:
Effective January 1, 2010, procedure codes 64470 through 64476 have been deleted and replaced with 64490 – 64495, defined as follows, and cpt code 77003 should not be billed with these codes:
64490 – Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), cervical or thoracic; single level
64491 – Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), cervical or thoracic; second level (List separately in addition to code for primary procedure)
64492 – Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), cervical or thoracic; third and any additional level(s) (List separately in addition to code for primary procedure)
64493 – Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), lumbar or sacral; single level
64494 – Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), lumbar or sacral; second level (List separately in addition to code for primary procedure)
64495 – Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), lumbar or sacral; third and any additional level(s) (List separately in addition to code for primary procedure)
Billed for more than 3 levels by the same physician for the same beneficiary on the same day
Bilateral procedures are billed with the RT and LT modifiers instead of the 50 modifier
Billed without using fluoroscopic guidance, CPT 77003.
64633 Destruction by neurolytic agent (including thermal, RFA), paravertebral facet joint nerve, cerv/thoracic single
64634 Destruction by neurolytic agent (including thermal, RFA), paravertebral facet joint nerve, cerv/thoracic each additional
64635 Destruction by neurolytic agent (including thermal, RFA), paravertebral facet joint nerve, L/S single
64636 Destruction by neurolytic agent (including thermal, RFA), paravertebral facet joint nerve, L/S each additional
27096 Injection SI Joint, with arthogram and/or anesthetic/steroid injection, with fluoro (fluoro code 77003). (If no fluoro, use code 20610)
64787 Implantation of nerve end into bone or muscle (list separately in addition to neuroma excision)
use with epidurogram code 72275
use with fluoro code 77003-26 (hospital will use 77003-TC for the technical component)
Discography
72295 lumbar, radiological supervision and interpretation
