A cisternogram is done to demonstrate the flow and track of cerebro-spinal fluid around the head. It is done to ensure there are no leaks of cerebrospinal fluid out of the body (through the nose, for instance) and also to diagnose a brain condition known as NPH (normal pressure hydrocephalus). The interventional radiologist performs a lumbar puncture and introduces a small amount of isotope into the spinal fluid. Pictures of the patient's head and back are taken about four hours later and then again after 24 hours.
The appropriate code to describe this procedure is 78630 (Cerebrospinal fluid flow, imaging [not including introduction of material]; cisternography) for the radiological side.
Depending on site of the puncture, one of the following injection codes would apply:
•62310 - Injection, single (not via indwelling catheter), not including neurolytic substances, with or without contrast (for either localization or epidurography), of diagnostic or therapeutic substance(s) (including anesthetic, antispasmodic, opioid, steroid, other solution), epidural or subarachnoid; cervical or thoracic
•62311 - ... lumbar, sacral (caudal).
Since your dictation specifies injection into the subarachnoid space, this procedure should resolve with 62310.
You can charge for fluoroscopy only if the radiologist does not read the cisternogram. If you charge the RS&I (radiological supervision and interpretation), you can't charge the fluoroscopic guidance because it is included in RS&I.
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