# Discogram followed by CT



## cswift (Aug 18, 2011)

I was wondering if anyone can advise if it is appropriate to charge a CT w/Contrast following a Discogram?  Thanks for any info!

CSwift CPC


----------



## jgf-CPC (Aug 18, 2011)

Since they will be looking at the CT with the contrast injected by the discogram you would charge a CT with contrast but not for the contrast itself since it was injected during the discogram. Hope that makes sense and helps!


----------



## cswift (Aug 18, 2011)

Thank you for taking the time to respond to me!  So, since the contrast is injected into the disc and not intravascularly, intra-articularly, or intrathecally, per the CPT book, then it is ok to charge for a CT w/Contrast?


----------



## jgf-CPC (Aug 18, 2011)

Yes, since the contrast is still there while the CT is being done then it would be read as with contrast. As long as you do not charge for it.


----------



## cswift (Aug 22, 2011)

Great! Thank you so much!


----------



## donnajrichmond (Aug 22, 2011)

jgf-CPC said:


> Since they will be looking at the CT with the contrast injected by the discogram you would charge a CT with contrast but not for the contrast itself since it was injected during the discogram. Hope that makes sense and helps!



This is incorrect.  The guidelines in CPT for contrast usage (beginning of Radiology section) are quite clear that to be considered a "with contrast" CT or MRI, the contrast must be injected IV, intrathecally or intra-articularly.  Contrast for a diskogram does not meet any of those - it is injected intradiscally.  Therefore the CT is "without contrast".


----------



## jgf-CPC (Aug 22, 2011)

I hope this clarifies my explanation of the contrast being there during the CT:

Needles are inserted through the back into the disc near the suspect area, guided by fluoroscope imaging. Fluid is then injected to pressurise the disc, any pain responses are recorded.

This is repeated in random order for the various discs, without the patient knowing which disc is pressurised. This can be used to detect patients who may be exaggerating their symptoms, or to assess their pain response and hence their suitability for recovery from possible surgery (often a Discectomy).

A *contrast agent is introduced*, and after the procedure a CT scan identifies leakage from the discs to identify any spinal disc herniation.


----------



## donnajrichmond (Aug 22, 2011)

jgf-CPC said:


> I hope this clarifies my explanation of the contrast being there during the CT:
> 
> Needles are inserted through the back into the disc near the suspect area, guided by fluoroscope imaging. Fluid is then injected to pressurise the disc, any pain responses are recorded.
> 
> ...



Yes, but look at your description- the contrast is injected into the disc.  It is not injected intrathecally nor is it IV. .  Just the fact that there is contrast does not mean that a "with contrast" CT should be coded.  You do not code "with contrast" for an exam where only oral contrast is given, even though there is contrast seen in the images.  Nor would you code a "with contrast" exam for a CT of the urinary tract when the contrast is injected through a bladder catheter.  Contrast is seen on the CT but it is still a "without contrast" exam.


----------

