Anesthesia Coding Alert

Pain Management Tip:

Balance Your Numbers of Diskograms and Interpretations

Published on Sun Aug 21, 2005

Don't let unequal reporting cost you reimbursement

The use of diskograms versus MRI scans and other less invasive diagnostic techniques by pain management practitioners can vary from one group to the next. If your physicians are in the "pro diskogram" camp, get all the reimbursement you deserve by correctly reporting both sides of the equation: the diskogram and the interpretation.

Physicians perform diskograms as preliminary diagnostic procedures to determine disk pathology, says Hal Nelson, CPC, vice president of anesthesia with the consulting firm CompONE Services in Atlanta.

Physicians also use diskography to diagnose problems associated with chronic back pain, recent back injury, tingling in the feet or sciatic pain, says Barbara Johnson, CPC, MPC, owner of the consulting firm Real Code Inc. in Moreno, Calif.
Tip: Some common diagnosis codes associated with these types of conditions include 722.90 (Other and unspecified disc disorder; unspecified region) for discogenic disease, many codes from the 722.x series (Intervertebral disc disorders) for protrusion, 724.5 (Backache, unspecified) for chronic back pain and 724.3 (Sciatica) for sciatic pain.

Base Your Codes on Location and Number

Physicians typically evaluate two or three disks during the session, Nelson says. CPT includes two codes for diskography, depending on the area treated:

CPT 62290 - Injection procedure for diskography, each level; lumbar

CPT 62291 - ... cervical or thoracic.

Because these are "each level" codes, you report all injections individually. Example: If the physician performs diskography at L1-2, L3-4 and L4-5 during the same session, report 62290 three times on the claim.

Secure Supervision and Interpretation Pay

Once you've reported each diskography level, don't rush to the next claim. Instead, follow CPT's note that directs you to the second part of the procedure: supervision and interpretation.

In some facilities - primarily teaching hospitals and larger medical centers - the radiologist often performs the interpretation and report, Johnson says. If that's the case in your facility, only code for the diskography. But if your physician also performs the supervision and interpretation, consider adding these codes to your claim:

72285 - Diskography, cervical or thoracic, radiological supervision and interpretation

72295 - Diskography, lumbar, radiological supervision and interpretation.

Even if you remember to report supervision and interpretation, Nelson says some coders make a very basic mistake: they only report 72285 or 72295 once for the entire procedure. That can really affect your bottom line because these are "each level" codes even though CPT doesn't spell it out.

"The reason people lose revenue on these procedures is because of the code descriptor term 'per level'," says Nelson. "According to the AMA, this means 'per disk,' not 'per region of the spine' (lumbar, thoracic, etc.)."

Although there should be a 1:1 ratio with injection and interpretation codes for diskograms, Nelson says coders seem to rarely balance the injection codes with the corresponding radiological interpretation codes. "Groups that are billing these incorrectly often have a 3:1 ratio for injections to interpretations."

Final detail: If you are able to code the interpretation, you'll often append modifier 26 (Professional component) to the radiological interpretation code. Physicians perform most of these procedures in an ambulatory or other outpatient setting, which means modifier 26 applies. However, if the physician performs the procedure in an office setting and uses his own equipment, do not append modifier 26.