Radiology Coding Alert

Question: Our radiologist performed a cervical myelogram and reported CPT 72240 , but his notes indicated a lumbar puncture. I would have expected his notes to reference cervical levels C1 or C2 for the puncture, in which case we could code 61055 (cisternal or lateral cervical [C1-C2] puncture; with injection of drug or other substance for diagnosis or treatment). How do I properly code this case?

Utah Subscriber

Answer: Because a puncture at the lumbar level is more readily accomplished, radiologists will most often perform the injection at that level for myelography (62284, injection procedure for myelography and/or computerized axial tomography, spinal [other than C1-C2 and posterior fossa]), regardless of which sections or levels are imaged. The radiologist will then tilt the table the patient is lying on to allow the contrast to flow into the precise area to be imaged. Therefore, correct coding in this instance would be 62284 and 72240 (myelography, cervical, radiological supervision and interpretation).

However, clinical circumstances sometimes demand a C1-C2 puncture. Reasons for this less common approach include inaccessibility of the lumbar puncture site or a blockage of flow of the instilled contrast media. In these cases the radiologist may code the C1-C2 injection code instead of, or in addition to, the more usual lumbar injection code.