Neurology & Pain Management Coding Alert

Question: Our neurologist saw a patient with a sacral Tarlov cyst. She is referring the patient to an interventional radiologist to have the cyst drained. I need the CPT and ICD-9 code to get this referral authorized. What should I use?

Florida Subscriber

Answer: For the diagnosis code, the ICD-9 alphabetic index directs coders to review 355.9 (Mononeuritis of unspecified site). You may also want to review 349.2 (Disorder of meninges, not elsewhere classified) with your neurologist as it is reported for spinal meninges cysts.

The method used to drain the cyst is important for coding, but you would most likely use 62268 (Percutaneous aspiration, spinal cord cyst or syrinx) for authorization of the procedure.

Tarlov cysts are cerebrospinal fluid (CSF) filled sacs typically located at the S1,S2, and S3 level of the sacrum. These cysts (also known as meningeal or perineural cysts) can compress nerve roots, causing lower back pain (724.2), sciatica (724.3), urinary incontinence (788.30), headaches (784.0), constipation (564.00), sexual dysfunction (302.70), and numbness in the leg and/or foot (782.0). Tarlov cysts often are diagnosed using magnetic resonance imaging.

-- Clinical and coding expertise for You Be the Coder and Reader Questions provided by Marvel J. Hammer, RN, CPC, CCS-P, ACS-PM, CHCO, owner of MJH Consulting in Denver.