Lower Back (Lumbar Spine) X-ray (with bending views)

What it is

The lumbosacral spine is the lower back: the five large vertebrae above the sacrum, plus the joint where they meet it. A standard series photographs that region from the front, the side, and at angles, with the patient standing or lying still. This code covers a longer study — six or more images — that includes flexion and extension views, taken with the patient bending forward as far as is comfortable and then leaning back. Comparing those two pictures shows whether the vertebrae hold their alignment through the movement or shift relative to one another. That shifting, which clinicians call instability, is invisible on any single static film, which is the whole reason the extra exposures are taken.

Why it is done

• To look for movement between vertebrae when one of them appears to have slipped forward on the one below it
• To assess a spine before or after fusion surgery, where the question is whether a segment still moves
• To evaluate the lower back after trauma, or in people with osteoporosis or long-term steroid use, where radiographs are a usual part of the workup
• To investigate back pain that has persisted despite treatment, rather than back pain that is new and uncomplicated

What to expect

Metal comes off and a gown usually goes on. For the bending views the patient stands at an upright detector and is asked to curl forward, hold still while an exposure is taken, then arch backward and hold again. How far to bend is limited by what hurts, and telling the technologist where the limit is changes nothing about the study's validity — the point is to capture the range that actually exists. The series takes longer than a plain two-view back X-ray, typically ten to fifteen minutes with the positioning. A radiologist compares the flexion and extension images and reports the difference.

Questions worth asking

• Do the bending views put this in a higher-priced code than a standard lumbar series, and was the full study the one ordered?
• If a prior lumbar X-ray or MRI exists, can it be used for comparison rather than repeating part of this study?
• Is the technical charge for the images and the professional charge for the radiologist's reading quoted together in any estimate I am given?
• If I cannot bend far enough for usable flexion and extension images, does the study still get billed at this code?