Ask Dr. Z

Which codes would you suggest if CT cisternogram as well as MR cisternogram were performed after intrathecal contrast injection? Would this be reported with codes 62323 and 78630?

"A 22 gauge standard 9 cm length spinal needle was used to access the spinal subarachnoid space under intermittent CT guidance. 10 mL Omnipaque 300. Initial test injection was performed with 1 mL of the Gadavist/Omnipaque mixture, with confirmation of intrathecal contrast by intraprocedural CT. After confirmation, the remaining 9.5 mL were injected. CT cisternogram and MR cisternogram demonstrated extravasation of intrathecally-administered contrast material into the left sphenoid sinus, most likely through a defect within the left aspect of the tuberculum sella/planum sphenoidale. Additional possible CSF leakage through a defect along the posterior right aspect of the floor of the sella turcica."