# myelogram with CT



## Shirleybala

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 .


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## RebeccaWoodward*

We do perform these and 62284 is correct for the myelogram.  Your "7" codes also appear to be correct.


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## Mouf1818

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


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## RebeccaWoodward*

*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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