Neurology & Pain Management Coding Alert

Do you know which of these procedures is diagnostic?

Though they are situated right next to each other in the CPT^® manual, disc decompression and discography are very different procedures.

How? For starters, one is diagnostic and the other is surgical. Also, you might be able to code for separate services in certain situations with these codes — but you have to know how to do it properly, or you’ll risk misfiling the claim.

Read on for the lowdown on disc decompression and discography.

First, Know Each Services’ Purpose

Obviously, you’ll need a firm grasp of the definitions of each procedure before proceeding. A disc decompression is “procedure to relieve pressure on the spinal nerves by correcting a bulge in an intervertebral disc. Commonly referred to as a percutaneous discectomy, it may be accomplished by several techniques, including non-automated (manual), automated, or laser,” explains Denise Caposella, coding expert in Delray Beach, Florida.

You’ll report these decompressions with 62287 (Decompression procedure, percutaneous, of nucleus pulposus of intervertebral disc, any method utilizing needle based technique to remove disc material under fluoroscopic imaging or other form of indirect visualization, with discography and/or epidural injection(s) at the treated level(s), when performed, single or multiple levels, lumbar).

Conversely, a discography is “an imaging procedure performed to gauge the amount of damage suffered by an intervertebral disc,” relays Caposella. You’ll report discographies with 62290 (Injection procedure for discography, each level; lumbar) or 62291 (… cervical or thoracic), depending on encounter specifics.

Bottom line: Disc decompressions are surgical, and discographies are diagnostic. If you find yourself coding for a “diagnostic” disc decompression or a “surgical” discography, you need to go back and check the notes again.

Also: Caposella reports that you need to be careful reporting both codes for the same patient during the same session, as discography is typically included in disc decompression. So unless the discography and decompression occur at different anatomical sites, report only 62287. “Keep in mind that because CPT^® includes the term ‘with discography’ in the code description [for 62287] it would not be appropriate to report 62290 or 62291 with 62287 when performed at the same level,” she says.

Look for Supervision/Interpretation With This Service

If the provider performs a discography with radiological supervision and interpretation, you should report either 72285 (Discography, cervical or thoracic, radiological supervision and interpretation) or 72295 (Discography, lumbar, radiological supervision and interpretation) in addition to 62290 or 62291. Pairing the correct supervision/ interpretation code with the correct discography code is vital in these instances.

According to Caposella, “72285 would be reported with 62291 when performed at the cervical or thoracic level; and 72295 would be reported with 62290 when performed at the lumbar level.”

Check Out This Clinical Example: No. 1

Caposella provided this clinical example of a patient who receives a disc decompression:

Preoperative diagnosis: Herniated disc of L4-5 and LS-S1 levels.

Encounter notes: The lower back was prepped and draped in the usual fashion and L4-5 disc space was identified. I injected local anesthesia using lidocaine 1 % with epinephrine with a #25-gauge 1.5 inch needle to the superficial skin and subcutaneous tissue. Once this was accomplished, the 150 mm Stryker needle was introduced in the direction of the L4-5 intervertebral space. The disc was successfully penetrated and aimed to the center of the disc at L4-5 in both AP and lateral views. Once this was accomplished under fluoroscopy, the trocar was removed from the needle and Stryker decompressor was inserted in such a way that approximately 1.5 g to 2 g of the disc material were removed with the decompressor.

Two passes were accomplished of 90 seconds each. Once this was accomplished, the instruments were removed from the space and all the disc material was passed through the scrub technician. Then, the 150 mm Stryker needle was introduced in the direction of L5-Sl intervertebral space. This was successfully penetrated under fluoroscopy. The trocar was removed from the needle and the Stryker decompressor was inserted and approximately 1.5 to 2 g of disc material was removed with the decompressor. Two passes of 90 seconds were done and the material was passed to the scrub technician. Then, the instruments were removed and the patient was awakened and taken to the recovery room in satisfactory condition.

Coding: For this encounter, you’d report 62287 for the decompression with M51.26 (Other intervertebral disc displacement, lumbar region) and M51.27 (Other intervertebral disc displacement, lumbosacral region) appended to represent the patient’s herniated discs.

“Because the CPT^® descriptor of code 62287 includes the term ‘single or multiple levels,’ only one unit of 62287 is assigned even when the procedure is performed on more than one level,” explains Caposella.

Check Out This Clinical Example: No. 2

Caposella also put forth an example in which a patient receives a disc decompression and a (separately reportable) discography:

Postoperative diagnosis: Herniated L3-4 disk left and L3-4 disc with stenosis and L4-L5 cyst with sequestered disc LS-SI.

Patient had progressive history of back and especially left leg pain from an auto accident.

Encounter notes: The skin was anesthetized 12 cm lateral to the midline over the posterior iliac crest, parallel to L3-4 disc space with 1 % Xylocaine. Small skin incision was made and then a #22-gauge spinal needle was obliquely passed down in the Codman’s triangle and posterior margin. At the L3-4 disc space we entered the disc space with a curved and endoscopic cannula. The probe was easily be able to move across and posterior in the disc space and in the midline and approximately 1cc to 1.5cc of disc material was removed. After this disc being done, an #18 gauge needle was used to approach the L5-S1 disc space from a superior-posterior angle view and a #22 gauge Chiba was then passed in the disc space. Dye was injected into the disc space and there was no communication from the disc space through the posterior margin of the canal where fragment had been seen on MRI scan.

For this encounter, Caposella says you should report:

• 62287 for the disc decompression.
• 62290 for the discography. (Remember, you can report this discography because it was performed at a different level than the decompression.)
• Modifier 59 (Distinct procedural service) appended to 62290 to show that it was a distinct and separate service from the decompression.