CPT® Code 70015

Official Description

Cisternography, positive contrast, radiological supervision and interpretation

Common Language Description

Cisternography, as defined by CPT® Code 70015, is a specialized radiographic examination that focuses on the basal cisterns of the brain. This procedure involves the use of a positive contrast medium, specifically iodinated contrast, which is injected into the subarachnoid space through a lumbar puncture. The purpose of using a positive contrast medium is to enhance the visibility of the structures within the brain during imaging, as it has a higher absorption of X-rays, appearing as white-gray on radiographic images. Cisternography is primarily utilized to assess conditions such as normal pressure hydrocephalus (NPH) and cerebral atrophy, where the flow and absorption of cerebrospinal fluid (CSF) may be compromised. Following the injection of the contrast medium, a series of radiographic images are captured over a period that can extend from hours to days, allowing for the observation of the contrast agent's movement through the brain's cisterns. In a typical scenario, the contrast medium ascends to the basal cisterns within 1 to 3 hours and subsequently collects in the sagittal area within 12 to 24 hours. In healthy individuals, the cisterns appear clear after 24 hours, and the ventricles are not visualized during the imaging series. Conversely, in patients with NPH, the reabsorption of CSF is hindered, leading to a reversal of flow, early visualization of the ventricles, and minimal movement of the contrast into the sagittal area, with ventricular reflux also noted in cases of isolated cerebral atrophy.

1. Indications

The indications for performing a cisternography using CPT® Code 70015 include the following:

Normal Pressure Hydrocephalus (NPH) This condition is characterized by an accumulation of cerebrospinal fluid (CSF) in the brain's ventricles, which can lead to increased intracranial pressure and various neurological symptoms. Cisternography helps evaluate the flow and absorption of CSF in suspected cases of NPH.
Cerebral Atrophy This refers to the loss of neurons and the connections between them, which can affect brain function. Cisternography is utilized to assess the flow of CSF and identify any abnormalities in patients with isolated cerebral atrophy.

2. Procedure

The procedure for cisternography involves several key steps, which are detailed as follows:

Step 1: Preparation The patient is positioned appropriately, and the area for lumbar puncture is cleaned and sterilized to minimize the risk of infection. The physician may explain the procedure to the patient to ensure understanding and cooperation.
Step 2: Injection of Contrast Medium A lumbar puncture is performed to access the subarachnoid space. The physician carefully injects the iodinated contrast medium intrathecally. This step is crucial as it allows the contrast to flow into the cerebrospinal fluid pathways, enabling visualization during imaging.
Step 3: Radiographic Imaging Following the injection, a series of radiographic images are taken over a specified period. These images are captured at intervals to monitor the movement of the contrast medium through the basal cisterns and into the sagittal area. The imaging may continue for several hours or even days, depending on the clinical scenario.
Step 4: Interpretation of Results After the imaging is completed, the radiologist supervises and interprets the results. The flow patterns of the contrast medium are analyzed to identify any abnormalities, such as impaired reabsorption of CSF in cases of NPH or changes indicative of cerebral atrophy.

3. Post-Procedure

Post-procedure care for patients undergoing cisternography typically includes monitoring for any immediate complications related to the lumbar puncture, such as headache or infection. Patients may be advised to remain hydrated and to rest for a period following the procedure. The results of the imaging will be reviewed by the physician, who will discuss the findings with the patient and determine any necessary follow-up actions or treatments based on the interpretation of the radiographic images.

Short Descr	CONTRAST X-RAY OF BRAIN
Medium Descr	CISTERNOGRAPHY POSITIVE CONTRAST RS&I
Long Descr	Cisternography, positive contrast, radiological supervision and interpretation
Status Code	Active Code
Global Days	XXX - Global Concept Does Not Apply
PC/TC Indicator (26, TC)	1 - Diagnostic Tests for Radiology Services
Multiple Procedures (51)	0 - No payment adjustment rules for multiple procedures apply.
Bilateral Surgery (50)	0 - 150% payment adjustment for bilateral procedures does NOT apply.
Physician Supervisions	09 - Concept does not apply.
Assistant Surgeon (80, 82)	0 - Payment restriction for assistants at surgery applies to this procedure...
Co-Surgeons (62)	0 - Co-surgeons not permitted for this procedure.
Team Surgery (66)	0 - Team surgeons not permitted for this procedure.
Diagnostic Imaging Family	99 - Concept Does Not Apply
APC Status Indicator	T-Packaged Codes
ASC Payment Indicator	Packaged service/item; no separate payment made.
Type of Service (TOS)	4 - Diagnostic Radiology
Berenson-Eggers TOS (BETOS)	I4B - Imaging/procedure - other
MUE	1
CCS Clinical Classification	209 - Radioisotope scan and function studies

26	Professional component: certain procedures are a combination of a physician or other qualified health care professional component and a technical component. when the physician or other qualified health care professional component is reported separately, the service may be identified by adding modifier 26 to the usual procedure number.
GC	This service has been performed in part by a resident under the direction of a teaching physician