Wiki myelogram with CT

Shirleybala

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Hi,
How to coded this myelogram,will these three codes come(62284, 72240, 72126) plz confirm

Technique: After 10 cc of Omnipaque 240 was administered into the
thecal sac, under fluoroscopic visualization, a CT cervical
myelogram was performed, with multiple axial CT images through the
cervical spine obtained. Sagittal and coronal reformats were then
performed. The images were reviewed in soft tissue and bone
windows.

Comparison is made with prior MRI done on 9/12/2008.

Findings:

There is straightening of the cervical spine seen. The cervical
alignment is normal. The vertebral body heights are preserved.
There is intervertebral disk space narrowing seen at the C5/6 and
C6/7 levels.

No intradural or paraspinal abnormality is seen. The cerebellar
tonsils are normal in position.

At the C2/3 and C3/4 levels, there are again noted small central
disk herniations, indenting the thecal sac without cord
compression, as observed on the prior MRI examination. The neural foramina are patent at these levels.

At the C4/5 level, there is a large left paracentral disk
herniation, resulting in moderate flattening of the ventral
spinal cord margin, as observed on the prior MRI examination. No
neural foraminal stenosis is observed.

At the C5/6 level, there is a left paracentral disk herniation,
resulting in mild-moderate flattening of the the ventral spinal
cord margin, as observed on the prior MRI examination. No neural
foraminal stenosis is observed.

At the C6/7 level, there is a left paracentral disk herniation,
resulting in mild-moderate flattening of the ventral spinal cord,
as observed on the prior MRI examination. Moderate left foraminal
stenosis is observed.

At the C7-T1 level, there is a minimal annular bulge without
spinal stenosis or cord compression.

There is minimal ossification the posterior longitudinal ligament
behind the C6 vertebral body.

IMPRESSION:

Multilevel disc herniations are observed at C2-3 through C6-7 with
associated anterior cord flattening at C4-5, C5-6, C6-7. Largest
disk herniation as well as the greatest degree of the anterior
cord flattening is at the C4-5 level. Minimal annular bulge is
also identified at C7-T1 .
 
be carefull with myelograms, you need to see where they puncture to inject the contrast...if it's in the lumbar spine then you use 62284 but if it's a cervical puncture you use 61055 (per interventional radiology book). If they don't state, you need to send back the report and have this confirmed because you can't guess. Your other codes are correct.:)

Amber, CPC
 
Myelography
Myelography is a diagnostic study utilizing contrast in order to visualize the spinal subarachnoid space and its contents. This study may be performed with attention to any or all areas of the spine. The contrast injection portion of the procedure is typically done through the lumbar area, and reported with CPT code 62284 (Injection procedure for myelography and/or CT, spinal). Injection of contrast for myelography may also be performed through the cervical region, which is reported with CPT code 61055 (Cisternal or lateral cervical (C1-C2) puncture, with injection of medication for diagnosis or treatment). The surgical code is reported only once per encounter, even if more than one spinal area is studied.2 For example, if the cervical, thoracic, and lumbar areas were all studied from one lumbar puncture, report 62284 only once; however, in the unusual case of a myelogram of the entire spine requiring both a lumbar and cervical puncture, report both 62284 and 61055.

I emphasized "however" because I have, yet, to see our neurosurgeons perform 61055. I have questioned why they don't/haven't performed this procedure, through this method, and I was told this was performed only when absolutley necessary. This method carries alot of potential risks.
 
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