Neurosurgery Coding Alert
Simply the Myelography Coding Process with these Tips
Know these keys to deciphering myelography dictation reports. If your neurosurgery practice handles myelography procedures, you probably know that there's a science to correctly coding myelographies. But in order to reach the correct set of codes every time, it's important to have a firm grasp on how these procedures actually work. Here's a quick refresher: Definition: Myelography is an imaging study performed to identify abnormalities within the subarachnoid space of the spine. This area between the spinal cord and the vertebrae is visualized using a contrast dye injection via fluoroscopic guidance. Physicians may also perform radiographic imagining such as x-rays and computed tomography (CT) scans alongside this procedure. Determining Site of Injection Myelography injections will most typically occur via the lumbar spine; with the alternative approach being a C1-C2 or posterior fossa injection. For cervical, thoracic, or lumbar myelographies via the C1-C2 or posterior fossa approach, you'll apply one (or more) of the following: If the injection follows the more traditional lumbar approach, you'll select from one of the following: Take note: If a physician performs a myelography via the C1-C2 or posterior fossa route, there is no combination code that includes both imaging and radiological supervision and interpretation. In cases where the physician performs both, you'll want to apply both the imaging and radiological supervision and interpretation codes (61055, 72240/72255/77265/72270). You will NOT include a fluoroscopic guidance code in addition to these two. Determine What Services Provider Performed Correct myelography coding requires a coder to be able to see whether the dictation supports an injection, radiological supervision and interpretation, or both. One of the most common misconceptions when coding myelographies is making the incorrect assumption that a fluoroscopic-guided myelography includes both imaging and injection codes (6230X). You would actually code a fluoroscopic-guided myelography (via the lumbar spine) as 62284/77003 rather than 6230X. The distinguishing factors between these two codes, however, can come down to one or two important keywords. Decide Between Fluoroscopic-Guided, Radiographic Myelography The dictation reports documenting these two procedures might look nearly identical at first sight. The key (and perhaps only) difference will be the description of radiographic imaging on the radiographic myelography. One of the most common pitfalls myelography coders face is making the assumption that a "spot film" is equivalent to radiographic imaging. On the contrary, "a fluoroscopy includes a spot film as an inherent part of the procedure," says Barry Rosenberg MD, chief of radiology at United Memorial Medical Center in Batavia, N.Y. "If true radiographic imaging is performed during the myelography – and the physician also performs the injection – you'll want to disregard the fluoroscopy code entirely as it's bundled into the combination code 6230X."
Related Articles
Neurosurgery Coding Alert
- NCCI Edits:
Familiarize Yourself with NCCI Sequential Procedures Policy
Rely on operative report and diagnoses to determine coding process. Those with a firm grasp [...] - ICD-10 Coding:
I.D. Appropriate ICD-10 Guidelines for these Scenarios
Fall back on your coding manual's guidelines when the going gets tough. No coder is [...] - CPT® Coding:
Simply the Myelography Coding Process with these Tips
Know these keys to deciphering myelography dictation reports. If your neurosurgery practice handles myelography procedures, [...] - You Be the Coder:
Billing Related E/M within 90-Day Global
Question: A patient presents for an evaluation and management (E/M) visit two weeks following a [...] - Reader Question:
Coding Hematomas with No Known Trauma
Question: How do I code a hematoma of the gluteus medius? Florida Subscriber Answer: Definitively [...] - Reader Question:
Include Appropriate Documentation, Justification with Modifier 22
Question: We submitted a claim with modifier 22 because the surgeon spent an extra 50 [...]
