Get a Clear Picture of Myelography Reporting

Get a Clear Picture of Myelography Reporting

Three factors weigh into choosing proper codes.

By John Verhovshek

Myelography or myelogram is an imaging procedure of the spine (myelo = spine, graphy = imaging) used to diagnose and locate spinal cord injuries, spinal stenosis, and other abnormalities of the spinal canal. Proper coding for myelography requires you to know: (1) the number of providers involved in performing the complete procedure; (2) the region of the spine imaged; and (3) whether any follow-up imaging was performed.

Complete Includes Both Injection and Radiological S&I

A complete myelography is a two-step procedure: A provider injects a contrast medium (step one), typically in the area of the lumbar spine. The contrast medium is a dye that disperses throughout the intrathecal space (the area surrounding the spinal cord), improving the visual contrast among structures viewed under the X-ray examination that follows (step two).

According to CPT® Assistant (September 2014), “An X-ray myelogram provides imaging of the entire region of the spine on a single image.” CPT® includes four codes to describe the complete procedure when performed by a single provider:

62302 Myelography via lumbar injection, including radiological supervision and interpretation;
cervical

62303 Myelography via lumbar injection, including radiological supervision and interpretation;
thoracic

62304 Myelography via lumbar injection, including radiological supervision and interpretation; lumbosacral

62305 Myelography via lumbar injection, including radiological supervision and interpretation; 2 or more regions (eg, lumbar/thoracic, cervical/thoracic, lumbar/cervical, lumbar/thoracic/cervical)

Code selection is based on the spinal region(s) targeted for visualization. For example, for myelogram of the thoracic spine, report 62303. For myelogram of the thoracic and lumbosacral regions during the same session, report 62305 (not 62303, 62304).

Injection or S&I Call for Different Coding

Codes 62302-62305 describe the bundled services of performing the contrast injection and radiological supervision and
interpretation (RS&I) of myelography. When reporting these codes, you may not separately report any of the following:

62284 Injection procedure for myelography and/or computed tomography, lumbar (other than C1-C2 and posterior fossa)

72240 Myelography, cervical, radiological supervision and interpretation

72255 Myelography, thoracic, radiological supervision and interpretation

72265 Myelography, lumbosacral, radiological supervision and interpretation

72270 Myelography, 2 or more regions (eg, lumbar/thoracic, cervical/thoracic, lumbar/cervical, lumbar/thoracic/cervical), radiological supervision and interpretation

These codes describe the individual components of myelography, including contrast injection (62284) and the radiological S&I (72240, 72255, 72265, 72270). As explained in CPT® Assistant (September 2014):

In the CPT® 2015 code set, the lumbar injection code and the X-ray myelogram RS&I code will be bundled if the same physician or other qualified health care professional does both [e.g., 62302-62305]. When the lumbar injection is administered by one physician or other qualified health care professional and the myelogram is interpreted by another, code 62284 should be used by the first physician or other qualified health care professional, and the appropriate X-ray myelogram code [72240, 7255, 7265, 72270] by the subsequent physician or other qualified health care professional.

For example, if Provider A performs a lumber injection of contrast medium, and Provider B performs the RS&I for cervical myelogram, coding is:

Provider A: 62284

Provider B: 72240

If Provider A performs a lumber injection of contrast medium, and Provider B performs the RS&I for cervical and thoracic myelogram, coding is:

Provider A: 62284

Provider B: 72270 (not 72240, 72255)

Note: You should report a single unit of 62284, per session, regardless of the number of spinal areas addressed (see CPT® Assistant, September 2004).

Separately Report Follow-up CT, when Performed

The provider may perform computed tomography (CT) following X-ray myelography. CPT® Assistant (September 2014) advises that you may report the CT separately by appending modifier 59 Distinct procedural service to the appropriate CT procedure code.

72126 Computed tomography, cervical spine; with contrast material

72129 Computed tomography, thoracic spine; with contrast material

72132 Computed tomography, lumbar spine; with contrast material

For example, a single provider performs the bundled service of contrast injection and cervical myelogram, followed by CT of the same spinal region. Coding is 62302 and 72126-59.

In a second example, Provider A introduces contrast via lumbar puncture. Provider B performs RS&I for cervical and lumbar myelogram, followed by CT of the same regions. Coding is:

Physician A: 62284

Physician B: 72270, 72126-59, 72132-59

If CT under contrast occurs without myelography, report the contrast injection (62284) and the appropriate CT code (72126-72132) without a modifier.


G.J. Verhovshek, MA, CPC, is managing editor at AAPC and a member of the Ashville-Hendersonville, North Carolina, local chapter.

2017-code-book-bundles-728x90-01

John Verhovshek

John Verhovshek

John Verhovshek, MA, CPC, is Managing Editor at AAPC. He has covered medical coding and billing, healthcare policy, and the business of medicine since 1999. He is an alumnus of York College of Pennsylvania and Clemson University, and a member of the Asheville-Hendersonville AAPC Local Chapter.
John Verhovshek

About Has 404 Posts

John Verhovshek, MA, CPC, is Managing Editor at AAPC. He has covered medical coding and billing, healthcare policy, and the business of medicine since 1999. He is an alumnus of York College of Pennsylvania and Clemson University, and a member of the Asheville-Hendersonville AAPC Local Chapter.

One Response to “Get a Clear Picture of Myelography Reporting”

  1. Barbara Schuchman says:

    Does the two code scenario (62284, 72240, for example) apply when the injection is performed by a PA and the myelogram is interpreted by the physician?

Leave a Reply

Your email address will not be published. Required fields are marked *