Radiology Coding Alert
Myelograms, Epidurograms and Nerve Blocks
Priscilla Moore
Duluth, Ga.
Answer: Myelograms of the brain are found under code 70010 (myelography, posterior fossa, radiological supervision and interpretation). Spinal myelograms are CPT codes 72240 (cervical), 72255 (thoracic), 72265 (lumbosacral), and 72270 (entire).
If your physician is performing the injection procedure as well, you will need to refer to code 61055 (cisternal or lateral cervical [C1-C2] puncture; with injection of drug or other substance for diagnosis or treatment) and 62284 (injection procedure for myelography and/or computerized axial tomography, spinal [other than C1-C2 and posterior fossa]), and bill them in addition to 70010, 72240, 72255, 72265, and 72270.
The CPT code for epidurography is 72275 (epidurography, radiological supervision and interpretation). The injection procedure codes would be selected from 62280-62282, 62310-62319 and 64479-64484, depending on the specific service offered. Nerve block codes are 64400-66484, depending on the agent and site injected. Codes 64470-64484 are unilateral procedures. For bilateral procedures, modifier -50 (bilateral procedure) should be used.
For fluoroscopic guidance, localization for needle placement, and injection in association with codes 64470-64484, you should use code 76005 (fluoroscopic guidance and localization of needle or catheter tip for spine or paraspinous diagnostic or therapeutic injection procedures, including neurolytic agent destruction). Fluoroscopic guidance for subarachnoid puncture for diagnostic radiographic myelography is included in the supervision and interpretation for codes 72240, 72255, 72265 and 72270.
All of these codes are on the Medicare fee schedule as being eligible for reimbursement. Medical necessity will determine payment or denial.
Reader questions were answered by Andrea Lamb, CPC, billing clerk for St. Josephs Medical Plaza, a multispecialty group practice in Buckhannon, W.Va.
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