Orthopedic Coding Alert

Do you know which of these procedures is diagnostic?

Codes that are listed close together in the CPT^® manual aren’t always similar; just check out percutaneous disc decompression and discography.

These are very different procedures despite their cozy proximity in CPT^®. For starters, one is diagnostic and the other is surgical. Also, you might be able to code for separate services in certain situations with these codes — but you have to know how to do it properly, or you’ll risk misfiling the claim.

Read on for the lowdown on percutaneous disc decompression and discography.

Step 1: Know Definitions of Each Service

Obviously, you’ll need a firm grasp of the definitions of each procedure before proceeding. A disc decompression is “procedure to relieve pressure on the spinal nerves by correcting a bulge in an intervertebral disc. Commonly referred to as a percutaneous discectomy, it may be accomplished by several techniques, including non-automated (manual), automated, or laser,” explains Denise Caposella, coding expert in Delray Beach, Florida.

You’ll report these decompressions with 62287 (Decompression procedure, percutaneous, of nucleus pulposus of intervertebral disc, any method utilizing needle based technique to remove disc material under fluoroscopic imaging or other form of indirect visualization, with discography and/or epidural injection(s) at the treated level(s), when performed, single or multiple levels, lumbar).

Conversely, a discography is “an imaging procedure performed to gauge the amount of damage suffered by an intervertebral disc,” relays Caposella. You’ll report discographies with 62290 (Injection procedure for discography, each level; lumbar) or 62291 (… cervical or thoracic), depending on encounter specifics.

Bottom line: Percutaneous disc decompressions are surgical, and discographies are diagnostic. If you find yourself coding for a “diagnostic” disc decompression or a “surgical” discography, you need to go back and check the notes again.

Also: Caposella reports that you need to be careful reporting both codes for the same patient during the same session, as discography is typically included in disc decompression. So unless the discography and decompression occur at different anatomical sites, report only 62287. “Keep in mind that because CPT^® includes the term ‘with discography’ in the code description [for 62287] it would not be appropriate to report 62290 or 62291 with 62287 when performed at the same level,” she says.

Match Supervision/Interpretation With Proper Code

If the provider performs a discography with radiological supervision and interpretation, you should report either 72285 (Discography, cervical or thoracic, radiological supervision and interpretation) or 72295 (Discography, lumbar, radiological supervision and interpretation) in addition to 62290 or 62291. Pairing the correct supervision/interpretation code with the correct discography code is vital in these instances.

According to Caposella, “72285 would be reported with 62291 when performed at the cervical or thoracic level; and 72295 would be reported with 62290 when performed at the lumbar level.”