Examine This Comprehensive Guide to Spinal Myelography Codes
Pay attention to spinal region when coding myelography. Conditions affecting or centered around the patient’s spine require special care and attention when performing tests to evaluate the body structure. Physicians use myelography to image the spinal cord and surrounding structures to accurately identify the ailment. Read on to understand myelography and how to choose the correct codes for your claim. What Is Myelography? Myelography is an imaging procedure where the provider inserts a spinal needle into the patient’s spinal canal to inject contrast material into the subarachnoid space, which surrounds the spinal cord and nerve roots. This procedure uses fluoroscopy, a real-time form of X-ray. The injected contrast material and fluoroscopy results in detailed images called myelograms, which the radiologist interprets to assess the spinal cord, nerve roots, and protective membranes (meninges). Fluoroscopy enables real-time observation of the contrast material flow, while permanent images, or radiographs, document any abnormalities that may be present. The radiologist may follow the myelogram with a CT scan to capture more precise anatomical details and identify abnormalities. Know Why a Provider Performs Myelography Myelography is a diagnostic procedure that helps identify issues related to the spinal cord, spinal canal, and nerve roots. The procedure can be useful in diagnosing conditions such as the following: Myelography is particularly valuable when an MRI cannot be performed or when additional information is required regarding: A healthcare provider may recommend a myelogram test if you have recently undergone surgery, especially if you are experiencing new or ongoing pain or weakness after the procedure. Ensure Thorough Documentation Supports the Choice of Codes One of the factors affecting your code selection is where the injection takes place. The spine has specific regions, so ensure the provider specifies whether the injection location is cervical, thoracic, or lumbar. Another element influencing your procedure code choice is the method used. Myelography is typically performed through the lumbar spine, with options for C1-C2 (or posterior fossa) injection as an alternative. Accurate myelography coding requires coders to assess whether the documentation indicates injection, radiological supervision, interpretation, or a combination of these elements. Watch out: A common misconception is that fluoroscopic-guided myelography includes both imaging and injection codes, such as 62302-62305 (Myelography via lumbar injection, including radiological supervision and interpretation …). However, you should code a fluoroscopic-guided myelography (i.e., via the lumbar spine) with 62284 (Injection procedure for myelography and/or computed tomography, lumbar) and +77003 (Fluoroscopic guidance and localization of needle or catheter tip for spine or paraspinous diagnostic or therapeutic injection procedures (epidural or subarachnoid) (List separately in addition to code for primary procedure)) instead of one of the 62302-62305 codes. The key difference between these two codes hinges on one or two important keywords. The dictation reports for fluoroscopic-guided and radiographic myelography procedures may seem similar at first glance. The main difference lies in the description of radiographic imaging in the radiographic myelography. Get to Know Myelography Codes Below are the most common CPT® codes used for coding and billing myelography procedures: Codes 62302-62305 all describe myelography via lumbar injection, along with radiological supervision and interpretation. Your code choice varies on the myelography region or regions. When the provider does not perform both the injection and radiological services, the injecting provider should report the appropriate injection code, such as 62284. The radiological provider should report the appropriate code from this range: The physician may also perform myelography by injecting contrast through the patient’s posterior cranial fossa. In that case, you’ll bill 70010 (Myelography, posterior fossa, radiological supervision and interpretation). Remember: Pay attention to parenthetical notes following the codes for additional instructions on reporting different procedures. For example, following 62304 is a note directing you to not report the code “in conjunction with 62284, 62302, 62304, 62305, 72240, 72255, 72265, 72270.” Comply With Coding Guidelines There may be rare instances where one provider supervises the radiology service while another interprets it. According to Medicare guidelines, each provider must report the radiology code and append modifier 52 (Reduced services). Additionally, each should append modifier 26 (Professional component) to the code to report only the professional component. When assigning a code with a descriptor that includes contrast, the contrast must be intravascular, intraarticular, or intrathecal, per CPT® guidelines. Depending on the payer’s guidelines, providers supplying contrast may also report it using 99070 (Supplies and materials (except spectacles), provided by the physician or other qualified health care professional over and above those usually included with the office visit or other services rendered (list drugs, trays, supplies, or materials provided)) or the appropriate HCPCS Level II code. It is essential to check individual payers’ policies for contrast coverage and reportable supply codes. Suppose you report only the interpretation or professional component for X-rays taken using portable equipment. In that case, you should report the same service code from the range for Radiology procedures (70010 to 79999) that you would report for nonportable services. Ensure you report a place of service (POS) code to reflect where the doctor performed their services. Remember This Advice While the codes listed above include the most common myelography CPT® codes, always select the codes that best represent the procedure performed, as documented by the provider. Currently, there are no national coverage determinations (NCDs) or local coverage determinations (LCDs) in place. The Centers for Medicare & Medicaid Services (CMS) has published articles pertaining to “Billing and Coding: Independent Diagnostic Testing Facility (IDTF),” referenced as A53252 and >A57807. Additionally, it is always a good idea to check the Medicare Administrative Contractor (MAC) carrier for your state for any articles with guidelines your facility or provider must follow for proper coding, documentation, and billing. Sharonn Johnson, CPC, Sr. Manager of Professional Audit, Coding & Education Services (PACE) 
at Pinnacle Enterprise Risk Consulting Services in Haysville, KS
