Orthopedic Coding Alert

Remember to check with your payer for its approved ICD-10 list.

When reporting discography procedures, you'll have a lot on your plate. You need to choose from one of the following coding strategies, based on encounter specifics:

• 62290 (Injection procedure for discography, each level; lumbar) and 72295 (Discography, lumbar, radiological supervision and interpretation), per level; or
• 62291 (... cervical or thoracic) with 72285 (Discography, cervical or thoracic, radiological supervision and interpretation), per level.

(Note: If a radiologist performs the interpretation, then the orthopedist reports only the injection code.) 

Did you know? The documentation for these discography claims must include proof of prior treatment methods and, in some cases, certain diagnosis codes.

Your provider can consider lumbar discography "for patients who have disabling lower back pain, groin pain, hip pain, and/or leg pain, even after extensive therapy or treatment," explains Denise Caposella, CPC, senior consultant with Acevedo Consulting Incorporated in Delray Beach, Florida.

Not only must a patient have a qualifying condition for discography coding, you're likely to need to document previous attempts to pinpoint the pain in the notes. "When a variety of spinal diagnostic procedures have failed to determine the primary cause of the pain, these patients may be deemed appropriate for lumbar discography" - especially if the provider is considering recommending spine surgery, Caposella says.

Best bet: It is important to check with third-party payers and Medicare for their accepted coding conventions when it comes to discography, confirms Mary I. Falbo, MBA, CPC, CEO of Millennium Healthcare Consulting, Inc. in Lansdale, Pennsylvania.

The acceptable coding could vary greatly depending on payer and patient situation. Consider this example from Falbo:

"Aetna considers lumbar provocative discography medically necessary for evaluation for disc pathology in persons with persistent, severe low back pain [LBP] andabnormal interspaces on magnetic resonance imaging [MRI], where other diagnostic tests have failed to reveal clear confirmation of a suspected disc as the source of pain, and surgical intervention is beingconsidered."

However, Falbo continues: "Aetna considers lumbar provocative discography experimental and investigational for all other indications - such as lumbosacral radiculopathy and chronic nonspecific back pain when criteria above are not met - because its effectiveness for indications other than the ones listed above has not been established."

Check Out these Dx Codes Related to Discography

While individual payer policies and situations will vary, patients who require lumbar, cervical, or thoracic discography could have one of the following diagnoses:

Note: This is not a comprehensive list, and all claims are subject to individual payer rules. If you have any doubt as to whether a payer covers discography for a certain diagnosis code, check with the payer before proceeding with the procedure.