G919 – Percutaneous epidural adhesiolysis by infusion with fluoroscopic guidance
OHIP Diagnostic & Therapeutic Procedures Code — DIAGNOSTIC AND THERAPEUTIC PROCEDURES · Schedule of Benefits
Percutaneous epidural adhesiolysis by infusion with fluoroscopic guidance. Note: G919 is only eligible for payment if it is used for the treatment of epidural fibrosis with symptoms of persistent back or radicular/neuropathic leg pain following spinal surgery.
When to Use
- Use G919 specifically for patients with documented epidural fibrosis causing persistent radicular pain following spinal surgery who have failed prior fluoroscopically-guided epidural steroid injections.
- Reserve this code for cases where you have ruled out other pain generators like facet-mediated or sacroiliac joint-mediated pain through clinical assessment.
Common Pitfalls
- Billing G919 without explicit documentation of the one-hour infusion of hypertonic saline and hyaluronidase will trigger an audit rejection.
- Attempting to bill G919 alongside G918 or G246 for the same procedure is prohibited and will result in a claim rejection.
- Failure to document the use of a directional epidural catheter and confirmation of its position via contrast is a frequent cause for recovery of funds during audits.
Billing Tips
- Ensure your procedure note explicitly states the sequence of events: directional catheter placement, contrast confirmation, one-hour hypertonic saline/hyaluronidase infusion, and final corticosteroid injection.
- Monitor your patient's service frequency, as G919 is strictly limited to a maximum of 4 services per patient per 12-month period.
Effective: April 1, 2025
J. Diagnostic and Therapeutic Procedures
DIAGNOSTIC AND THERAPEUTIC PROCEDURES
Procedure
Diagnostic and Therapeutic Procedures
The medical record must document that the service is for the treatment of epidural fibrosis with symptoms of persistent back or radicular/neuropathic leg pain following spinal surgery.
The use of fluoroscopic guidance must be documented.
The medical record must document that the patient has had inadequate symptom control following fluoroscopically-guided epidural steroid injections to the suspected site of pain generation and there is no alternate primary diagnosis, such as facet-mediated or sacroiliac joint-mediated pain.
The medical record must document that the service is rendered with fluoroscopic guidance using a directional epidural catheter, with its final position confirmed using contrast.
The medical record must document that hypertonic saline and hyaluronidase are infused for at least one hour.
The medical record must document that epidural corticosteroid is injected prior to catheter removal.
G919 is only eligible for payment if the following conditions are met: 1. it is used for the treatment of epidural fibrosis with symptoms of persistent back or radicular/neuropathic leg pain following spinal surgery;
2. the patient has had inadequate symptom control following fluoroscopically-guided epidural steroid injections to the suspected site of pain generation and there is no alternate primary diagnosis, such as facet-mediated or sacroiliac joint-mediated pain; and
3. it is rendered with fluoroscopic guidance using: a. a directional epidural catheter, with its final position confirmed using contrast; b. hypertonic saline and hyaluronidase, which are infused for at least one hour; and c. epidural corticosteroid, which is injected prior to catheter removal.
4. G919 is limited to a maximum of 4 services per patient per 12 month period.
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