![]() 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. ABBREVIATIONS: AMA American Medical Association CPT Current Procedural Terminology ![]()
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