Part B Insider (Multispecialty) Coding Alert

Question: Our radiologist obtains MR assisted 3D images in a patient with suspected CSF leak in the sinuses. This procedure has been documented as a MR cisternogram. We are not sure if we should report this as an MR procedure or just cisternography. Please help.

Answer: The best approach is to select a code based on what was performed rather than going by the name of the examination. Since you radiologist is obtaining MR images, code 70551 (Magnetic resonance [e.g., proton] imaging, brain [including brain stem]; without contrast material) may be more appropriate than 78630 (Cerebrospinal fluid flow, imaging [not including introduction of material]; cisternography).

Typically a cisternogram involves injection of isotopes. The interventional radiologist performs a lumbar puncture and introduces a small amount of isotope into the spinal fluid. Pictures of the patient’s head and back are taken about four hours later and then again after 24 hours

What is a cisternogram? A cisternogram is done to demonstrate the flow and track of cerebrospinal fluid around the head. It is done to ensure there are no leaks of cerebrospinal fluid (through the nose, for instance). It may also help to diagnose a normal pressure hydrocephalus.