JUNE 2014

Percutaneous Decompression of Nucleus Pulposus

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 injection(s) at the treated level(s), when performed, single or multiple levels, lumbar

When you read the description of this CPT code there is a lot going on, so let’s break the code down into its different components.

1. Decompression procedure, percutaneous, of nucleus pulposus of intervertebral disc, any method utilizing needle based technique.

  • First of all this is a “percutaneous” procedure so no incision is made
  • The keyword here is “nucleus pulposus” – the nucleus pulposus is found in the center of the intervertebral disc and has a tooth paste like consistency. To identify this procedure the physician will usually dictate passing the device through the outer portion of the disc (annulus fibrosis) and into the “nucleus pulposus”
  • Any method – as long as there is a needle based technique would be included in 62287. The most common method of decompression is done using radiofrequency, but there is a recent CPT Assistant that states use of a high-velocity water jet system to decompress the disc would also be reported with 62287.

Example:

Thetrocar was placed at the posterior aspect of the nucleus just deep to the annular fibers. The decompression device was then advanced under fluoroscopic guidance until it reached a point in the anterior aspect of the nucleus pulposus abutting the anterior annulus. Decompression was then stared.

2. Use of fluoroscopy, any type of indirect visualization or an endoscope – because this is a percutaneous procedure imagining is required for insertion of the instrument and any positional adjustments during the procedure – therefore the imagining/guidance is included in code 62287 and not additionally reported.

3. Injection procedures either discography or epidural injections are also included at any of the treated levels, however I have seen procedures where a discography is performed at as many as three different levels but the decompression is only performed at one level. In those instances I would recommend reporting 62287 for the level that is decompressed and then additionally report the appropriate number of levels where only the discography (62290) was performed without decompression.

4. Single of multiple levels, lumbar – two important things to note.

  • 62287 is only reported one time regardless of the number of levels treated.
  • 62287 is only reported for decompression procedures performed in the LUMBAR region.







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