Radiology Coding Alert

Question: Which code should we use for intervertebral disc biopsy for discitis? I’m considering 20220, 62267, or 62269.

Louisiana Subscriber

Answer:  Your best choice is 62267 (Percutaneous aspiration within the nucleus pulposus, intervertebral disc, or paravertebral tissue for diagnostic purposes). If the physician used fluoroscopic guidance, also report 77003 (Fluoroscopic guidance and localization of needle or catheter tip for spine or paraspinous diagnostic or therapeutic injection procedures [epidural or subarachnoid]).

You should include the appropriate diagnosis from 722.9x (Other and unspecified disc disorder) for the discitis. The codes in this family are delineated by region (unspecified, lumbar, thoracic, or cervical), so verify the anatomic site to select the best diagnosis. The corresponding ICD-10 codes are even more site specific:

• M46.40, Discitis, unspecified, site unspecified
• M46.41, Discitis, unspecified, occipito-atlanto-axial region
• M46.42, Discitis, unspecified, cervical region M46.43, Discitis, unspecified, cervicothoracic region
• M46.44, Discitis, unspecified, thoracic region
• M46.45, Discitis, unspecified, thoracolumbar region
• M46.46, Discitis, unspecified, lumbar region
• M46.47, Discitis, unspecified, lumbosacral region
• M46.48, Discitis, unspecified, sacral and sacrococ­cygeal region
• M46.49, Discitis, unspecified, multiple sites in spine.
  

Caution: You mentioned you were also considering whether 20220 (Biopsy, bone, trocar, or needle; superficial [e.g., ilium, sternum, spinous process, ribs]) or 62269 (Biopsy of spinal cord, percutaneous needle) would apply to this situation. These codes would not be appropriate. Code 20220 refers to a bone biopsy, and the intervertebral disc is not a bone. Also, the descriptor for 20220 applies to a “superficial” procedure, which is less involved than an “intervertebral disc biopsy.” Code 62269 would not apply because you’re coding for a biopsy of the intervertebral disc instead of the spinal cord. The spinal cord is not the same anatomically as an intervertebral disc.