Neurosurgery Coding Alert

Question: What is the difference between disc decompression and an injection for discography?

North Carolina Subscriber

Answer: When the provider performs a percutaneous disc decompression, you should report 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).

Notice: The code descriptor for 62287 includes indirect visualization because disc decompression is percutaneous, and the surgeon needs to use fluoroscopy to visualize the placement and maneuvering of the needle.

Some providers may refer to a 62287 procedure as a percutaneous discectomy. The surgeon could use several techniques for this decompression, including non-automated (manual), automated, or laser. You should report one unit of 62287 regardless of the number of vertebral levels the provider injects, or the type of visualization he uses. While some providers will concurrently perform diagnostic discography with the percutaneous discectomy, this would be considered incidental to the therapeutic procedure and not separately reportable.

On the other hand, you should report either 62290 (Injection procedure for discography, each level; lumbar) or 62291 (... cervical or thoracic) for an injection for discography. Codes 62290 and 62291 represent only the injection of radio-iodine contrast for a discography. This code includes each level performed for the lumbar spine only.

That means that for each lumbar level your provider injects, you should report one unit of 62290. The same holds true for 62291 and cervical/thoracic levels. If the provider also performs radiological supervision and interpretation services for the discography, you may additionally report 72285 (Discography, cervical or thoracic, radiological supervision and interpretation) for radiological supervision and interpretation when performing cervical/thoracic discography and 72295 (Discography, lumbar, radiological supervision and interpretation) when performing lumbar discography. If the provider does not own the equipment, you should append modifier 26 (Professional component) for professional services only (and the facility will report the same radiological supervision and interpretation code with modifier TC (Technical component) for the technical services).