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There are different codes for different spinal areas.

Patients who report to the neurosurgeon for discography can pose a coding challenge if you aren鈥檛 ready. Sometimes, the discography is the only service the surgeon provides; other times, the service is part of a larger surgical package.

Knowing the difference will make your discography claims sail through the first time, every time. Check out this rundown on the different ways to code discography.

Know How to I.D. Discography

First, you need to know what a discography entails.

In short, a discography is an imaging procedure performed to gauge the amount of damage suffered by an intervertebral disc. The physician directs a needle at a 45-degree angle to the center line toward the spine and the needle is monitored radiographically.

A small needle is then inserted through the original needle once it reaches the lamina. The physician pushes this needle to the disc and injects 1-2 mL of contrast medium.

If you see a description of the surgeon鈥檚 actions like this in the encounter notes, be on the lookout for discography coding opportunities.

Discover Who Needs Discography

A patient who needs a discography will almost certainly have had more conventional attempts at determining their pain source. When a variety of spinal diagnostic procedures have failed to determine the primary cause of the patient鈥檚 pain, they may be deemed appropriate for lumbar discography 鈥� especially if the physician is considering surgery for the problem.

Discography may be considered for patients who have disabling lower back pain, groin pain, hip pain, and/or leg pain, even after extensive therapy or treatment.

Once the surgeon performs a discography, they should be able to identify the patient鈥檚 specific problem. Conditions that your surgeon might identify with discography include, but are not limited to:

• Acquired spondylolisthesis
• Spondylosis with/without myelopathy
• Spinal stenosis
• Intervertebral disc disorder
• Thoracic or lumbosacral neuritis or radiculitis
• Intervertebral disc displacement
• Intervertebral disc degeneration
• Schmorl鈥檚 nodes
• Sciatica
• Post-laminectomy syndrome
• Dislocation of lumbar vertebra, open/closed.

Diagnostic Discography Is a Multi-Code Affair

When the surgeon performs the discography purely for diagnostic purposes, your coding will depend on anatomy and how many levels the surgeon injects. Diagnostic discography is composed of two elements, both of which are codeable.

The first step in the procedure is the injection of radio-iodine contrast for the discography. You鈥檒l choose your code based on anatomy; 62290 (Injection procedure for discography, each level; lumbar) for lumbar injections and 62291 (鈥� cervical or thoracic) for cervical/thoracic injections. Know that the CPT^庐 descriptors for 62290 and 62291 read 鈥渆ach level,鈥� meaning you should report a code for each spinal level the surgeon injects.

Note: Payers differ on how they want you to report multiple injections in the same spinal area, even though the codes explicitly state 鈥渆ach level鈥�; some might want to see modifiers 51 (Multiple procedures) or 59 (Distinct procedural service) on each code after the first injection, while others might have another reporting method in mind.

The second step in the procedure is the actual discography, which includes interpreting a discogram. Codes for this service also depend on anatomy; 72295 (Discography, lumbar, radiological supervision and interpretation) for lumbar discography and 72285 (Discography, cervical or thoracic, radiological supervision and interpretation) for cervical/thoracic discography.

You should report 72295 or 72285 for each level the provider performs interpretation and supervision for. Be sure to follow the coding convention of the payer when reporting these codes more than once.

Look Out for Discography-Inclusive Codes

While a discography might be the only service your surgeon provides, it could also be part of a larger procedure. When the surgeon performs a surgery that includes discography, you cannot code separately for any part of the discography.

One of the codes that includes discography is 62287 (Decompression procedure, percutaneous, of nucleus pulposus of intervertebral disc, any method utilizing needle based technique to remove disc material under fluoroscopic imaging or other form of indirect visualization, with discography and/or epidural injection(s) at the treated level(s), when performed, single or multiple levels, lumbar). This is a decompression procedure to relieve pressure on the spinal nerves by correcting a bulge in an intervertebral disc. Your surgeon might also refer to 62287 as a percutaneous discectomy, and it may be accomplished by several techniques, including non-automated (manual), automated, or laser.

Another code that includes discography is 62292 (Injection procedure for chemonucleolysis, including discography, intervertebral disc, single or multiple levels, lumbar). In chemonucleolysis, the surgeon injects an enzyme into a lumbar vertebral disc to dissolve the bulging nucleus pulposus.

If the surgeon performs discography at the same level(s) as they do either of these surgeries, you cannot code the discography or the injection separately.

Chris Boucher, MS, CPC, Senior Development Editor, AAPC