4/21/2024 0 Comments Cpt code x ray cervical spineBecause myelography and contrast-enhanced CT of the lumbar spine occurred in the same patients, the National Correct Coding Initiative was concerned that these concurrent procedures may be unnecessary and duplicative. The National Correct Coding Initiative flagged myelography and contrast-enhanced CT of the spine and submitted a query to the AMA requesting clarification. Perhaps, the single most important message of this article is that one should not code for a myelogram when one is using x-ray imaging simply to document the intrathecal location of the needle placement and contrast injection.ĭistinct from the Relativity Assessment workgroup screen of the AMA, the National Correct Coding Initiative of the Centers for Medicaid and Medicare Services reviews codes for potential misuse. Specialized techniques such as flexion, rotation, and hyperextension to show spinal stenosis and lateral recess stenosis are tools chosen by the provider as trouble-shooting techniques of assessment as contrast disperses in the thecal sac. A myelogram is not a single image documenting needle placement but a comprehensive evaluation of the contrast-enhanced thecal sac with assessment of each exit foramen for pathology. 7 Fluoroscopic gastrointestinal studies require maneuvers to move contrast so too are patient and table maneuvers often used as tools to evaluate canal stenosis, leaks, complications of surgery, and spinal instrumentation. Myelography is a comprehensive radiographic examination of the spine following intrathecal injection of iodinated contrast media, involving assessment of static structures such as the spinal canal and each exit foramen, and dynamic, real-time assessment of contrast injection and its flow dynamics under direct visualization. Of note, we intentionally used “providers” instead of “physicians” because allied health professionals or other qualified health care providers (eg, nurse practitioners) can also perform and increasingly code these procedures, 4, 5 especially because diagnostic imaging volume has increased with time. This review will provide clarity for physicians and coders who wish to enhance their familiarity with these changes. The authors illustrate these complexities with recent updates to the differentiation of x-ray and CT with intrathecal contrast media and the unintended consequences of revaluation of the original codes. The effects of this recent bundling, 2, 3 including the interplay among radiologic modalities, are important for neuroradiologists. The work of the CPT Editorial Panel and advisors is published in the CPT manual and educational materials in an effort to provide coding clarity and preserve the intended coding integrity of medical procedures. CPT, owned and trademarked by the American Medical Association (AMA), provides physicians, including neuroradiologists, an opportunity to directly participate in the creation of procedural codes. The Current Procedural Terminology (CPT) system has been the national medical coding standard in the United States 1 since 2000. The remainder of the duodenal loop and the upper jejunum mucosal pattern are within normal limits.ABBREVIATIONS: AMA American Medical Association CPT Current Procedural Terminology Prolapse of gastric mucosa into the base of the bulb is seen. The duodenal bulb fills out well, and this structure is noted to be slightly distorted in configuration however, no ulcer crater of the duodenal bulb is appreciated. No additional site of gastric ulceration or other abnormality is seen. There is a suggestion of a small ulcer crater of the lesser curvature aspect of the pyloric canal of the stomach. The mucosal pattern of the stomach is not unusual. No reflux of gastric contents into the esophagus or radiographic signs of esophagitis can be seen. The stomach is readily entered, peristalsis traverses this organ in normal fashion, and a very small sliding type of hiatus hernia of the stomach is seen on one of the radiographs. Diagnostic Radiology: UPPER GASTROINTESTINAL SERIES: Radiographic examination of upper gastrointestinal tract that includes scout abdominal radiographs, double-contrast study, reveals no abnormalities of the swallowing mechanism or of the entire esophagus.
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