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Radiology Coding Alert

Reader Question:
How to Code a Cisternogram

Question: I've never coded a cisternogram before. The procedure notes say that the needle was placed at the L3/4 interspace level, and the doctor injected 500 microcuries of indium-111 DTPA into the subarachnoid space. I'm particularly in need of some help with the injection code. Our diagnostic radiology department does the injection procedure under fluoroscopic guidance. Which codes would be appropriate to bill from the diagnostic department? The department has it hard-coded to 62270* (Spinal puncture, lumbar, diagnostic). I think that's wrong, but I'm not sure what the correct choice would be. Georgia Subscriber Answer: A cisternogram is done to demonstrate the flow and track of cerebro-spinal fluid around the head. It is done to ensure there are no leaks of cerebrospinal fluid out of the body (through the nose, for instance) and also to diagnose a brain condition known as NPH (normal pressure hydrocephalus). The interventional radiologist performs a lumbar puncture and introduces a small amount of isotope into the spinal fluid. Pictures of the patient's head and back are taken about four hours later and then again after 24 hours.

The appropriate code to describe this procedure is 78630 (Cerebrospinal fluid flow, imaging [not including introduction of material]; cisternography) for the radiological side. Depending on site of the puncture, one of the following injection codes would apply:
62310 Injection, single (not via indwelling catheter), not including neurolytic substances, with or without contrast (for either localization or epidurography), of diagnostic or therapeutic substance(s) (including anesthetic, antispasmodic, opioid, steroid, other solution), epidural or subarachnoid; cervical or thoracic
62311 ... lumbar, sacral (caudal). Since your dictation specifies injection into the subarachnoid space, this procedure should resolve with 62310. You can charge for fluoroscopy only if the radiologist does not read the cisternogram. If you charge the RS&I (radiological supervision and interpretation), you can't charge the fluoroscopic guidance because it is included in RS&I. Reader Questions and You Be the Coder were answered by Gary Dorfman, MD, FACR, SIR, president of Health Care Value Systems in North Kingstown, R.I.; Cindy Parman, CPC, CPC-H, RCC, co-owner of Coding Strategies Inc., an Atlanta-based firm; and Phillip C. Seeger BS, RT(R), of Lakeland Regional Health System Radiology Department in St. Joseph, Mich.

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