Anesthesia Coding Alert

Hot tips on coding 3 common procedures Learning the ins and outs of disk procedure coding can be tricky, but knowing the tricks of the trade often means more accurate claims and better reimbursement. Read on for tips from the 2004 American Academy of Professional Coders (AAPC) national conference on coding for common disk procedures. Know Your Anatomy Being familiar with the spine's structure helps you better understand -- and accurately report -- disk procedures.

The normal anatomy of the spine is usually described by dividing it into three major sections: the cervical, thoracic and lumbar spine. The bone below the lumbar spine (the sacrum) is part of the pelvis. Individual bones called vertebrae make up each section of the spine.

A disk lies between each of the vertebrae, acting as a shock-absorbing pad. Each one contains an outer band (the annulus fibrosus) that encases a gel-like substance (the nucleus pulposus). Nerve roots exit the spinal canal through small passageways between the vertebrae and disks.

Pain and other symptoms can develop when a damaged disk pushes into the spinal canal or nerve roots. With so many components in these intricate structures, it's no surprise that you're coding for so many disk procedures. Separate Notes Distinguish Diskography When a patient first presents with disk pain, the physician often performs diskography to assess the situation. One thing sets diskography apart from other pain management procedures -- it is a diagnostic procedure, not therapeutic.

Some carriers may not reimburse for a diskogram if the patient recently had a myelogram (72240-72270). That's because the two techniques are somewhat similar, though a diskogram provides more information about the disk's actual disease.

Hint: Asking the simple question "Have you had a recent myelogram?" can mean the difference between reimbursement or denial for diskography. If the answer is "Yes," check the carrier's guidelines regarding myelograms and diskograms before scheduling the procedure.

Once the physician performs diskography, code all of its components correctly. Each level of injection is separately billable:

62290 -- Injection procedure for diskography, each level; lumbar
62291 -- ... cervical or thoracic. These codes each represent 20 RVUs (relative value units). You receive payment for each level injected and documented, but remember that the multiple reduction guidelines apply.

The physician also uses fluoroscopy for needle placement; report this with 76005 (Fluoroscopic guidance and localization of needle or catheter tip for spine or paraspinous diagnostic or therapeutic injection procedures [epidural, transforaminal epidural, subarachnoid, paravertebral facet joint, paravertebral facet joint nerve or sacroiliac joint], including neurolytic agent destruction) once per session. Code supervision and interpretation for each level with 72285 (Diskography, cervical or thoracic, radiological supervision and interpretation) or 72295 (Diskography, lumbar, radiological supervision and interpretation) as appropriate. No [...]