Myelography CPT Coding Updates: Effects of 4 New Codes and Unintended Consequences

Abstract

SUMMARY:The Current Procedural Terminology of the American Medical Association has recently introduced coding changes for myelography with the introduction of new bundled codes. The aim of this review was to help neuroradiologists understand these code changes and their unintended consequences and to discuss various scenarios in which permutations of various codes could occur in clinical practice.

Diagnostic Quality of 3D T2-SPACE Compared with T2-FSE in the Evaluation of Cervical Spine MRI Anatomy

“…Conventional T2-FSE images are often wrought with pulsation artifact, 11 which greatly diminishes their utility in visualizing thecal sac contents, especially small structures such as the rootlets. Many patients undergo invasive CT myelography 12 or contrast-enhanced MR myelography 13 to interrogate these structures. The ability of T2-SPACE to better identify the rootlets could be helpful in clinical diagnosis and surgical planning because no intrathecal contrast is needed and there is no radiation exposure.…”

Current Procedural Terminology: History, Structure, and Relationship to Valuation for the Neuroradiologist

“…It is important to emphasize that the CPT descriptor for myelography includes a thorough radiographic (plain film) examination of the spine after intrathecal injection of iodinated contrast media, involving assessment of static structures, such as the spinal canal and each exit foramen, and real-time assessment of contrast injection and its flow dynamics under direct visualization. 18 It is not appropriate to code for a formal myelogram when x-ray imaging is simply used to document the intrathecal location of needle placement and contrast injection.…”

“…Stakeholders led by the neuroradiology subspecialty societies provided clarification to CMS, which was accepted, and the edit was not pursued further beyond adding the -59 modifier when CT of the spine with contrast media is used with the myelography codes. 18…”

Health Care Economics: A Study Guide for Neuroradiology Fellows, Part 2

“…The National Correct Coding Initiative, which is the CMS counterpart to the Relativity Assessment Workgroup, also reviews codes for possible misuse. 21 It was the National Correct Coding Initiative that identified 2 procedures, plain-film myelography and contrast-enhanced spinal CT as discussed above, requesting clarification from the AMA. The CMS was concerned that these concurrent procedures were potentially unnecessary and duplicative.…”