2017 Edition of Common Coding Scenarios for
Comprehensive Spine Care Now Available!
2017 Common Coding Scenarios for Comprehensive Spine Care includes medical and
surgical coding vignettes, key components to include in the procedure notes and
proper coding of spine procedures for 2017.
n Updated CPT® codes to reflect recent
n CPT® codes for Evaluation and
n CPT® codes 22000 series, 63000 series and
n CPT® codes for Injection, Pain
Management, Radiology and
n 2017 Medicare Physician Fee Schedule
n Ambulatory Surgical Centers (ASC) list of
For more information and to order this
essential coding resource, please visit www.
spine.org or call NASS toll free at 866-960-NASS (866-960-6277).
formed with contrast administration.
Different S&I codes are used for CT and
MRI for “without contrast” and “with
contrast.” Codes that indicate “with
contrast” are used when intravascular,
intra-articular or intrathecal contrast
are injected as part of the imaging study
but are not used when oral and/or rectal
contrast are used alone nor when CT
is performed after intradiscal contrast
injection for discography. Sometimes
it is appropriate to perform an initial
imaging study without contrast and then
administer intravascular or intrathecal
contrast, followed by additional imaging
of the same anatomic region during the
same episode of care. A separate set of
codes for CT and MRI that include both
with and without contrast portions of the
In some instances, 3D rendering of
spine imaging will clinically indicate, in
which cases medical necessity should
be documented in the health record.
Two supplemental codes, 76376 and
76377, are used for 3D rendering with
interpretation and reporting of CT,
MRI, ultrasound, or other tomographic
modality with image post processing
under concurrent supervision. This is
not requiring image post processing on
an independent work station (76376) or
image post processing on an independent work station (76377).
Users can render a group of 2D projections of a 3D discretely sampled data
set via 3D rendering. It is not the same
as multi-planar reconstruction (MPR),
which is a volume built by stacking
axial slices and constructing images in
a different plane (ie, sagittal or coronal).
MPR is included in the base code for
these imaging studies.
Physicians are strongly recommend-
ed to maintain a permanent archive of
the 3D rendered images. Please note
that these codes were modified in 2013
to include “concurrent supervision” as
they are used for the additional work
incurred by the physician directly per-
forming or supervising the technologist
in producing 3D rendered images. It is
recommended that the concurrent su-
pervision includes active participation
in and monitoring of the reconstruction
process that includes:
n Design of the anatomic region to be
n Determination of the tissue types and
actual structures to be displayed.
n Determination of the images or cine
loops that are archived.
n Monitoring and adjustment of the 3D
work product (ACR Coding Source).
These supplemental codes have come
under greater scrutiny in recent years
and should not be routinely used. Documenting medical necessity is important
when using these codes and including it
in the written interpretation.
Documentation of imaging and
image guided procedures includes sev-
eral key components. The following are
adapted from the 2017 NASS Common
Coding Scenarios book:
n Date of examination.
n Informed consent obtained (when
applicable for pregnancy, contrast
n Sedation, if given (include medica-
tion for sedation, dose and intra-
service monitoring time if billing
separate moderate sedation codes
99151-99155. Keep in mind this re-
quires continuous face-to-face atten-
dance of the physician or other quali-
fied health professional and there
must be an independent trained
observer to assist in monitoring the
patient’s level of consciousness and
physiological status throughout the
procedure if the physician/qualified
health professional providing the
sedation services is also performing
n Contrast, if given (type, amount and
concentration). Include adverse re-
action if applicable.
n Anatomic areas scanned, list specific.
n Post processing if applicable (espe-
cially if not inherent to the exam; ie,
3D rendering including indication).
n Any portions of the exam not
n Dictate report of findings with an