Wiki Biopsy-Can we code

[prabha]

Can we code the following report with 10160 & 77012.If not, what would be the appropriate code?Kindly clarify...

Clinical history: History of L4-5 discitis.
Procedure:

With the patient in prone position contiguous 5 mm axial images
were obtained with a grid localizer overlying the right paraspinal
region. A suitable skin site was then selected, prepped and draped
in the usual sterile manner and locally anesthetized with 1%
lidocaine. Under CT guidance a 17-gauge needle was advanced from
above the right iliac wing, down and medially and positioned with
the tip in a pocket of low density material in the L4-5 disc space
itself.

Approximately 2-3 cc of clear, yellow serous fluid was aspirated.
Specimens were sent for both bacterial cultures, fungal and TB. An
additional specimen was handed to the cytopathologist.

At the end of the procedure a sterile dressing was applied.

Impression:
CT-guided aspiration of fluid in the L4-5 disc space. Aspirated
2-3 cc clear, yellow serous fluid. Specimen sent for culture and
sensitivity, AFB, fungal, and a specimen was also given to the
cytotechnologist. No immediate complications.

 

[preserene]

I would like to locate it under the Sugery/Nervous System (Spine and the Spinal Cord.
So,the surgery coding- I would report as 62267

 

[Shirleybala]

what will be the guidance code for CT, As crosswalks leads to 77003Fluoroscopic guidance and localization of needle or catheter tip for spine or paraspinous diagnostic or therapeutic injection procedures (epidural, transforaminal epidural, subarachnoid, or sacroiliac joint), including neurolytic agent destruction

 

[preserene]

Biopsy at Intervertebral Disc the area of the given case:

10160 is a surgical code for general and as well abscess ,hematoma,bulla or cyst. It is not applicable to the case presented to you.
It is a percutaneous needle Biopsy other than fine needle aspiration . As per the guide lines, 62267 is the one for nucleus pulposus, IV disc (Nucleus pulposus and annulus fibrosus: ( Iv Discs form the inferior half of the anterior border of the IV foramen).
For Computer Tomography Guidance for needle placement, I strongly feel that 77012 is more appropriate.
Code number 77003, I feel does not apply here, because it is specific with medical necessity for
77003 FLUOROSCOPIC GUIDANCE AND LOCALIZATION OF NEEDLE OR CATHETER TIP FOR SPINE OR PARASPINOUS DIAGNOSTIC OR THERAPEUTIC INJECTION PROCEDURES (EPIDURAL, TRANSFORAMINAL EPIDURAL, SUBARACHNOID, OR SACROILIAC JOINT), INCLUDING NEUROLYTIC AGENT DESTRUCTION
Because the area of our question, is INTERVERTEBRAL DISC/DISC SPACE. All those included in this code (parenthesis list of areas)do not include IVDISC / SPACE. Secondly, the parenthetical note down the code 77003 , says that 77003 descriptive procedure is INCLUDED IN 62267- PERCUTANEOUS ASPIRATION WITH THE NUCLEUS PULPOSUS, IV DISC OR PARAVERTEBRAL SPACE FOR DIAGNOSTIC PURPOSES.
This case under our discussion, is a procedure undertaken with diagnostic guidance(CT) and biopsy for diagnostic purpose not therapeutic.
So as for me, I think, it is appropriate to code: professional-62267; and radiological component 77012
{Because it involved CT as diagnostic which do not bundle the procedure).
But the procedure code 62267 will suffice, (if it is nor for CT guidance), if radiological service provided with injection of contrast during fluoroscopic guidance and localization , the code 77003 is not needed since it is included in 62267.}
Please let me be corrected and clarified, if this is wrong.
Thank you.