G919 – Percutaneous epidural adhesiolysis by infusion with fluoroscopic guidance

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.