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.
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.
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.
once, regardless of the number of levels treated at one session.
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