Lumbar Myelogram

Katiemkf

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When billing for CT Lumbar myelography we have always used the following codes:

62284/72265

We have recently merged with another hospital and their staff is adamant that the proper code selcetion is 62284/77003. Below is an example of a report;

Indication: Low Back Pain

Informed consent was obtained. The patient was cleaned and prepped in the usual sterile fashion. After injecting local anesthetic, a 20 g needle was advanced and entered into the thecal sac at L3 level. Clear CSF returned 15 cc Omnipaque-180 s injected intrathecally and myelogram was performed. The procedure was tolerated well and there were no complications.

Findings: The vertebral body height and alignment is well-maintained. The thecal sac is well filled with contrast. L4-L5 disc space is diminished indicated of degenerative changes noted.

IMPRESSION: A lumbar myelogram was performed. The degenerative changes at L4-L5 level. Please refer to CT study of lumbar spine for further details.

Any feedback is greatly appreciated.
 

mhstrauss

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When billing for CT Lumbar myelography we have always used the following codes:

62284/72265

We have recently merged with another hospital and their staff is adamant that the proper code selcetion is 62284/77003. Below is an example of a report;

Indication: Low Back Pain

Informed consent was obtained. The patient was cleaned and prepped in the usual sterile fashion. After injecting local anesthetic, a 20 g needle was advanced and entered into the thecal sac at L3 level. Clear CSF returned 15 cc Omnipaque-180 s injected intrathecally and myelogram was performed. The procedure was tolerated well and there were no complications.

Findings: The vertebral body height and alignment is well-maintained. The thecal sac is well filled with contrast. L4-L5 disc space is diminished indicated of degenerative changes noted.

IMPRESSION: A lumbar myelogram was performed. The degenerative changes at L4-L5 level. Please refer to CT study of lumbar spine for further details.

Any feedback is greatly appreciated.



For starters, the note you have posted here doesn't mention fluoro at all (unless I overlooked it), so if this is a typical procedure note, it definitely doesn't support the use of 77003. We also use the same 62284/72265 as you stated above. Here's a link to an ACR article that supports this:

http://www.acr.org/Hidden/Economics/FeaturedCategories/Pubs/coding_source/archives/MarchApril2006/CodingofDiagnosticandTherapeuticSpinalProceduresDoc6.aspx

Hope this helps! :)
 

jmcpolin

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I do not see the fluoro either, but if they are doing the injection and then sending them to CT you would bill the injection, and the CT would be billed with contrast.
 

Rhurst1

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Myelogram

This reads like a conventional or radiographic myelogram.

In this case you would be able to bill for the injection 62284 and the myelogram 72240,72255,72265,72270, depending on the area being performed. The fluoro is included in the myelogram. To me, the big clue is the physician is reporting his findings, which means he did more than just an injection. However, he does need to state the guidance for the injection.

If the patient is then sent on to CT for additional scans, they would be charged per spinal area, of course with contrast.


If the patient is having only a CT myelogram performed, which means the physician is only doing the injection and no films at the time of injection, then sending the patient to CT, the following codes would apply. 62284 injection, 77003 fluoro spine, and the appropriate CT code with contrast for the spinal area accordingly.

Good Luck!
 
Last edited:

moserk

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Megan,
By any chance can you copy and paste the info you have on the ACR website? I am not a paid subscriber, so I cannot access the information.
I'm trying to find documentation for coding CPT 62284, 77003 and 72265

Thanks so much
K
 

mhstrauss

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Megan,
By any chance can you copy and paste the info you have on the ACR website? I am not a paid subscriber, so I cannot access the information.
I'm trying to find documentation for coding CPT 62284, 77003 and 72265

Thanks so much
K
Wow, I just tried to go to that link, and it "does not exist"...not sure what happened there. I'm not a paid subscriber either, but I can usually access some pretty good articles on that site. I'll see if I can pull it up a different way. Sorry! :confused:
 
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