Anesthesia Coding Alert

Question: There seems to be a lot of confusion surrounding coding for myelography injections (62284*, Injection procedure for myelography and/or computerized axial tomography, spinal [other than C1-C2 and posterior fossa]). Should 62284 be billed in addition to diagnostic or therapeutic injections, such as 62310? Texas Subscriber Answer: A myelogram is a diagnostic study of the spine using injected liquid contrast material to aid in visualizing the spinal canal and associated structures. CPT 2002 indicates that 62284 is for surgical procedure only. Therefore, it is also modifier -59 (Distinct procedural service) exempt. Usually, this small surgical service (injection) is performed by a radiologist with the radiological procedure, such as 72240 (Myelography, cervical, radiological supervision and interpretation). Occasionally, a pain management specialist also may provide a diagnostic or therapeutic injection (i.e., 62310, Injection, single [not via indwelling catheter] of diagnostic or therapeutic substance[s] cervical or thoracic) during the myelographic procedure. If the pain management provider also performs the contrast injection, he or she cannot bill both codes because in this situation 62284 is bundled with 62310. Additionally, Palmetto GBA, the Medicare Part B carrier for South Carolina, states in its LMRP, "CPT code 62284 should not be billed when contrast material is injected into the epidural space during placement of an epidural catheter."