# Myloegraphy with pain pump trial injection



## celcano (Mar 16, 2015)

My physician sis an "intrathecal injection of fentanyl for intrathecal pump trial".
His report reads:  "The skin and subcutaneous tissues were anesthetized with 1% Lidocaine using a 25-gauge 1-1/2 inch needle.  After that, an 22-gauge, 3-1/2 inch spinal needle was advanced into the right L2-L3 interspace.  The needle's position was verified in both AP and lateral views.  A free flow of clear CSF was obtained.  50 mcg fentanyl was given intrathecally.  IV dye contrast was used, it showed great intrathecal placement, no filling defect with contrast or stenosis."

In addition to  CPT 62311, he wants to bill myleography (72265).  I don't see any CCI edits, but I am wondering if this is appropriate?  If it is appropriate, is there enough documentation as this is the only report.

Thank you!


----------



## dwaldman (Mar 17, 2015)

AMA CPT Assistant Sept 2014 states: "A myelogram is* not * a report describing only a few images documenting intrathecal needle placement"

They go on to point out that the injection procedure and the interpretation code (62284, 72265) have been bundled when performed by the same physician and is reported under

62304  
Myelography via lumbar injection, including radiological supervision and interpretation; lumbosacral  

When looking at the NCCI edit for CPT 62311 and CPT 62304, it states they are bundled and modifier is not allowed to override the relationship.


Code 62304(column 1) has a CCI conflict with code 62311(column 2). A modifier is not allowed to override this relationship. 

There is not a separate provider performing injection for myelography so it would be inappropriate coding for the provider to report CPT 72265 due to this requirement of reporting CPT 72265.

Here is additional information below from AMA CPT Assistant.

In CPT?2015 code set, the codes for intrathecal contrast administration via lumbar injection and X-ray myelographic radiologic supervision and interpretation (RS&I) will be bundled into a single new code, when both procedures are performed by the same physician or other qualified health care professional on the same patient on the same day. If one physician or other qualified health care professional performs the lumbar injection and another interprets the myelogram, then each procedure is still reported separately. This update does not apply to intrathecal contrast injection administered via cervical injection. 

It is important to note that myelography should not be reported unless a complete myelographic procedure with full RS&I is performed. Myelography is not merely documentation of needle placement (see Features Unique to Myelography listed below). The supervision and interpretation for myelography should not be reported without the referring physician or other qualified health care professional requesting an X-ray myelogram. Request for a CT of the spine with intrathecal contrast does not constitute adequate justification for the additional X-ray myelogram. These requests are best coded as the injection code for myelography (via a cervical or lumbar injection) and the subsequent CT of the spine with contrast code


----------



## dwaldman (Mar 17, 2015)

(For myelography  injection and imaging performed by different physicians or other qualified health care professionals, see 62284 or 72240, 72255, 72265, 72270)

(When both 62284 and 72240, 72255, 72265, 72270 are performed by the same physician or other qualified health care professional for myelography, see 62302, 62303, 62304, 62305)


Above is from AMA CPT Changes 2015, and also found in the AMA CPT 2015 professional manual, which states reporting 72265 is only reported when a separate physician performed the injection portion of the procedure. 

They have created a new code that encompasses both the injection portion and interpretation performed by the same physician and this is reported as CPT 62304. The fact that NCCI has made this an edit where there is no circumstance a epidural during the same setting indicates they do not see this as a separately reported service.


62284

Injection procedure for myelography and/or computed tomography, lumbar


(Do not report 62284 in conjunction with 62302, 62303, 62304, 62305, 72240, 72255, 72265, 72270)(Do not report 62284 in conjunction with 62302, 62303, 62304, 62305, 72240, 72255, 72265, 72270)


(When both 62284 and 72240, 72255, 72265, 72270 are performed by the same physician or other qualified health care professional for myelography, see 62302, 62303, 62304, 62305)

(For injection procedure at C1-C2, use 61055)


(For radiological supervision and interpretation, see Radiology)


62302


Myelography via lumbar injection, including radiological supervision and interpretation; cervical


t(Do not report 62302 in conjunction with 62284, 62303, 62304, 62305, 72240, 72255, 72265, 72270)New or Revised Text(Do not report 62302 in conjunction with 62284, 62303, 62304, 62305, 72240, 72255, 72265, 72270)


62303

thoracic


Do not report 62303 in conjunction with 62284, 62302, 62304, 62305, 72240, 72255, 72265, 72270)(Do not report 62303 in conjunction with 62284, 62302, 62304, 62305, 72240, 72255, 72265, 72270)


62304

lumbosacral


(Do not report 62304 in conjunction with 62284, 62302, 62303, 62305, 72240, 72255, 72265, 72270)New or Revised Text(Do not report 62304 in conjunction with 62284, 62302, 62303, 62305, 72240, 72255, 72265, 72270)


62305

2 or more regions (eg, lumbar/thoracic, cervical/thoracic, lumbar/cervical, lumbar/thoracic/cervical)


(Do not report 62305 in conjunction with 62284, 62302, 62303, 62304, 72240, 72255, 72265, 72270)New or Revised Text(Do not report 62305 in conjunction with 62284, 62302, 62303, 62304, 72240, 72255, 72265, 72270)


(For myelography lumbar injection and imaging performed by different physicians or other qualified health care professionals, see 62284 or 72240, 72255, 72265, 72270)


----------

