Radiology Coding Alert

Payment and coding confusion increased two years ago when CPT Codes implemented new codes for diskography, myelography and epidurography. Since then, radiologists and coders have struggled to learn the new system and correctly pair codes that appropriately describe the work performed. You must understand the distinctions among these three categories of imaging study, each of which may be used to pinpoint the cause of back pain, says April Brazinsky, CCS, coding specialist for the Community Hospital of the Monterey Peninsula in California. Additionally, radiologists order diagnostic spinal injections to identify the precise anatomic location for administration of a spinal block as a secondary treatment during cancer therapy. Contrast is injected at various anatomic locations related to the spinal column, and radiographic images are obtained. These studies allow the radiologist to identify the source of the signs and symptoms, or to eliminate a specific cause and seek answers elsewhere. Report Diskography by Injection Level Defined as contrast imaging of the intervertebral disks, diskography ascertains the integrity of the intervertebral disk by using both the pressure of injected intradiskal contrast to reproduce the patient's symptoms and the appearance of the injected radiographic contrast material. This process allows the radiologist to see any cracks or fissures in the patient's vertebrae, notes Lisa Grimes, RT [R]), radiology special procedures technologist and reimbursement specialist for the University of Texas/Houston Health Science Center. ICD-9 Codes most often reported for diskography include disk herniation (e.g., 722.0, Displacement of cervical intervertebral disc without myelopathy), myelopathy (721.1, Cervical spondylosis with myelopathy) and radiculopathy (729.2, Neuralgia, neuritis, and radiculitis, unspecified). Diskography involves two components, she says, both of which can be coded: 1) an injection or surgical service and 2) radiological supervision and interpretation (RS&I) service. Coders would choose either 62290* (Injection procedure for diskography, each level; lumbar) or 62291* (... cervical or thoracic) depending on the injection's location. In addition, codes 72295 (Diskography, lumbar, radiological supervision and interpretation) for the lumbar region or 72285 (Diskography, cervical or thoracic, radiological supervision and interpretation) for the cervical or thoracic region would be paired with the corresponding injection code. In many cases, the physician performs several injections at various levels along the spine. The AMA allows both the injection and the RS&I codes to be reported multiple times. The code descriptions make this clear, outlining that the code is assigned for "each level." This indicates that the number of units should be indicated next to the code when the claim is submitted and that no additional modifier is necessary. For instance, if three injections were performed at three different levels of the lumbar spine, the coder would enter 62290 x 3.

Nonetheless, coding experts report that claims are often denied unless modifier [...]