Radiology Coding Alert

Question: Can someone tell me what cone-down views are with regard to doing lumbar views? Are these the same as bending views? The dictation reads, "Lumbosacral spine, ap, lateral and cone-down views." Missouri Subscriber Answer: Cone-down views usually constitute an additional lateral view of the same structure, but they focus more on a specific part and result in clearer pictures, says Phillip C. Seeger BS, RT(R), of Lakeland Regional Health System Radiology Department in St. Joseph, Mich.

"Cone-down views are performed in addition to the entire lateral spine to better visualize the lower lumbar/sacral spine and the joint space," Seeger says. Normally the pelvis bones are superimposed over the spine and causes this area to appear lighter on the film because there is more body tissue to penetrate with the x-rays. The coning-down, Seeger says, reduces scatter radiation and increases detail. Sometimes this view, which is established by facility protocol, is called the L5/S1 spot, he notes.

The correct code for this dictation would be 72100 (Radiologic examination, spine, lumbosacral; two or three views). Bending views are a little different and have a specific code associated with them: 72120 (Radiologic examination, spine, lumbosacral, bending views only, minimum of four views). The basic technique for performing the lateral bending views of the lumbar spine is as follows: The films are taken with the patient sitting on a stool with the back in close contact with the bucky to avoid any forward motion of the torso. The patient laterally flexes his or her spine to the limit without rising from the stool. The central ray is centered at the level of the third lumbar segment. Having the patient sit rather than stand blocks out the effects of the gross musculature (erector spinae) and amplifies the effects of the intrinsic musculature of the lumbar spine (quadratus lumborum, multifidus, intertransversarii, rotatores and psoas).