Look to Combination Code for Some Myelographies
Question: Encounter notes indicate that the PM specialist saw a patient with granulomas in the cervical and thoracic spinal areas. The specialist performed cervical and thoracic myelographies through lumbar injection. I reported 62302 and 62303-59 and we received a denial. How can I fix this claim to get it ready for resubmission? Alaska Subscriber Answer: First, we’ll discuss the correct coding for this encounter. Then, we’ll go through why you received a denial in the first place. On your claim, report 62305 (Myelography via lumbar injection, including radiological supervision and interpretation; 2 or more regions (eg, lumbar/thoracic, cervical/thoracic, lumbar/cervical, lumbar/thoracic/cervical)) for both myelographies. Remember to append G06.1 (Intraspinal abscess and granuloma) to 62305 to represent the patient’s granulomas. Coding prohibition: As you can see from the descriptor, 62305 covers both of your PM specialist’s myelographies. Even though you used modifier 59 (Distinct procedural service) with 62302 (Myelography via lumbar injection, including radiological supervision and interpretation; cervical) and 62303 (… thoracic), you can’t ever report those codes together. According to CPT®, you can only report one of the following codes per patient per encounter: 62302, 62303, 62304 (… lumbosacral), and 62305. Other prohibition: The 62302-62305 code set has additional restrictions you need to observe. You cannot report these codes with 62302-62305: Chris Boucher, MS, CPC, Senior Development Editor, AAPC
