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The procedure described by CPT® Code 62281 involves the injection or infusion of a neurolytic substance, which may include agents such as alcohol, phenol, or iced saline solutions. These neurolytic substances are specifically designed to destroy neural structures that are involved in the perception of pain, thereby providing long-lasting relief from pain. This procedure is commonly referred to as a neurolytic block and is particularly indicated for patients suffering from chronic, intractable, non-terminal pain that has not responded to other pain management strategies, as well as for those experiencing cancer-related pain. The neurolytic block can be administered either into the subarachnoid space, which is the area between the arachnoid mater and the pia mater surrounding the spinal cord, or into the epidural space, located between the bony vertebrae and the outermost membrane covering the spinal cord, known as the dura mater. The procedure typically requires the patient to be positioned on an X-ray table with their back exposed, allowing for proper access to the injection site. Prior to the injection, the area is cleansed, and a local anesthetic is applied to minimize discomfort. Fluoroscopic guidance, which is a type of real-time X-ray imaging, is utilized to accurately insert a spinal needle or cannula into the appropriate space. A small amount of contrast material is injected to confirm the correct positioning of the needle or cannula before the neurolytic substance is administered. It is important to note that different CPT codes are used depending on the specific location of the injection: CPT® Code 62280 is used for subarachnoid injections at any spinal level, CPT® Code 62281 is designated for epidural injections in the cervical or thoracic regions, and CPT® Code 62282 is for epidural injections in the lumbar or sacral (caudal) regions.
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The procedure described by CPT® Code 62281 is indicated for the following conditions:
The procedure begins with the patient being positioned on an X-ray table, ensuring that the back is exposed for access to the injection site. The area where the injection will be administered is thoroughly cleansed to reduce the risk of infection. Following this, a local anesthetic is applied to the site to minimize discomfort during the procedure. Using fluoroscopic guidance, which provides real-time imaging, a spinal needle or cannula is carefully inserted into either the subarachnoid space or the epidural space, depending on the specific treatment being performed. To confirm the correct placement of the needle or cannula, a small amount of contrast material is injected. This step is crucial as it ensures that the neurolytic substance will be delivered to the appropriate location. Once proper positioning is verified, the neurolytic substance, such as alcohol, phenol, or iced saline, is injected or infused into the targeted area. This process aims to destroy the neural structures involved in pain perception, thereby providing the patient with long-lasting pain relief.
After the procedure, patients are typically monitored for any immediate adverse reactions or complications. It is essential to observe the patient for signs of infection, bleeding, or any neurological deficits. Depending on the patient's response and the specific clinical scenario, further instructions regarding activity levels, pain management, and follow-up appointments may be provided. Patients may experience varying degrees of pain relief, and it is important to assess the effectiveness of the neurolytic block in subsequent visits. Additionally, patients should be informed about potential side effects and the importance of reporting any unusual symptoms following the procedure.
| Short Descr | TREAT SPINAL CORD LESION | Medium Descr | INJX/INFUS NEUROLYT SUBST EPIDURAL CERV/THORACIC | Long Descr | Injection/infusion of neurolytic substance (eg, alcohol, phenol, iced saline solutions), with or without other therapeutic substance; epidural, cervical or thoracic | Status Code | Active Code | Global Days | 010 - Minor Procedure | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 2 - Standard payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 0 - 150% payment adjustment for bilateral procedures does NOT apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 1 - Statutory payment restriction for assistants at surgery applies to this procedure... | Co-Surgeons (62) | 0 - Co-surgeons not permitted for this procedure. | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Procedure or Service, Multiple Reduction Applies | ASC Payment Indicator | Surgical procedure on ASC list in CY 2007; payment based on OPPS relative payment weight. | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P5E - Ambulatory procedures - other | MUE | 1 | CCS Clinical Classification | 5 - Insertion of catheter or spinal stimulator and injection into spinal canal |
This is a primary code that can be used with these additional add-on codes.
| 77003 | CPT Add On MPFS Status: Active Code APC N ASC N1 Physician Quality Reporting CPT Assistant Article Fluoroscopic guidance and localization of needle or catheter tip for spine or paraspinous diagnostic or therapeutic injection procedures (epidural or subarachnoid) (List separately in addition to code for primary procedure) |
| 51 | Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d). | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | GC | This service has been performed in part by a resident under the direction of a teaching physician | RT | Right side (used to identify procedures performed on the right side of the body) | SG | Ambulatory surgical center (asc) facility service |
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| 1992-01-01 | Added | First appearance in code book in 1992. |
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