Orthopedic Coding Alert

Remember, injection for discography is diagnostic, and a decompression is therapeutic.

If you see patients with back issues, your providers will likely often perform injection for discography or percutaneous disc decompression. When coding for these procedures, your bottom line could suffer if you mix up the coding conventions for these two procedures.

While it is true that CPT^® groups percutaneous disc decompression and injection for discography into the same part of the coding book, there are several differences between the two services.

Help's here: We've got the lowdown from the best in the business about how to choose the correct code every time your provider performs injection for discography or percutaneous disc decompression. Check out this FAQ on the most common questions when coding these services.

Q: What is the difference between disc decompression, injection for discography?

A: First, the codes are different depending on the service. When the provider performs a percutaneous disc decompression, you'll report 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), confirms Amy C. Pritchett, BSHA, CPC, CPMA, CPCI-I, CRC, CANPC, CASCC, CEDC, CCS, CMDP, CMPM, CMRS, C-AHI, ICDCT-CM, ICDCT-PCS, past president of the American Academy of Professional Coders chapter in Mobile, Ala.

You'll note that the descriptor for 62287 includes visualization; this is because disc decompression "is percutaneous, and the provider needs to use fluoroscopy or an endoscope to visualize the placement and maneuvering of the needle, explains Dreama Sloan-Kelly, MD, CCS, president of Dr. Sloan-Kelly Consulting in Shirley, Massachusetts.

So, you should report one unit of 62287 regardless of the number of vertebral levels the provider injects, or the type of visualization he uses. According to Denise Caposella, CPC, senior consultant with Acevedo Consulting Incorporated in Delray Beach, Florida, some providers refer to a 62287 procedure as a "percutaneous discectomy."

According to Caposella, the provider could use several techniques for this decompression, including non-automated (manual), automated, or laser.

While 62287 will work for your disc decompression claims, you'll code injection for discography procedures with either 62290 (Injection procedure for discography, each level; lumbar) or 62291 (... cervical or thoracic), confirms Caposella.

Remember that 62290 and 62291 represent only "the injection of radio-iodine contrast for a discography. This code includes each level performed for the lumbar spine only," says Pritchett. That means that for each lumbar level your provider injects, you'll report one unit of 62290. The same holds true for 62291 and cervical/thoracic levels.

"In summary, 62287 is a corrective procedure and 62290 [and 62291] are diagnostic procedures. Keep in mind that because CPT^® includes the term 'with discography' in the code description it would not be appropriate to report 62290 [or 62291] with 62287 when performed at the same level," explains Caposella.

Also, you should report 62290 or 62291 for each level that the provider treats; append either modifier 59 (Distinct procedural service) or 51 (Multiple procedures) to each unit of 62290 or 62291 after the first, if the payer calls for it.

Q: Will the provider typically perform additional services with these injections?

A: With disc decompression (62287), you typically won't be able to code for any other service, except perhaps an evaluation and management (E/M) service that precedes the procedure. Also, CPT^® bundles any discography procedure into 62287, so you won't often submit another procedure code with 62287.

Injection for discography, however, always includes another code assignment. If the provider performs lumbar injection for discography (62290), then you'll include 72295 (Discography, lumbar, radiological supervision and interpretation) to account for the imaging supervision and interpretation for a discogram, which is a study of the cartilaginous disc between two vertebrae. You should report 72295 for each level the provider performs interpretation and supervision for. If the payer calls for it, append either modifier 59 or 51 to each unit of 72295 after the first. (Note: If a radiologist performs the interpretation, then the orthopedist reports only the injection code.)

When the provider performs cervical or thoracic injection for discography (62291), you'll report 72285 (Discography, cervical or thoracic, radiological supervision and interpretation) to account for the supervision and interpretation at each level. If the payer calls for it, append either modifier 59 or 51 to each unit of 72285 after the first. (Note: If a radiologist performs the interpretation, then the orthopedist reports only the injection code.)

In contrast to a percutaneous disc decompression, discography is a two-code procedure. "Discography is a diagnostic study that injects contrast into the intervertebral disc, and you code based on level; 62290 and 72295 if lumbar, or 62291 and 72285 if cervical or thoracic region," reminds Sloan-Kelly. "The 62290 or 62991 codes are the injection procedure for the discography; the 72295 and 72285 codes are the discography procedure itself."