Anesthesia Coding Alert

Question: Our anesthesiologist worked with the oncologist on a case involving a lumbar puncture and intrathecal chemotherapy. The anesthesiologist completed the lumbar puncture and the oncologist completed the chemotherapy administration. Code 96450 includes both services, so we tried filing with modifier 80 and modifier 62. The payer denied everything. How should we report the procedure for both physicians?

North Carolina Subscriber

Answer: Does the documentation indicate why the bundled service was provided separately by the anesthesiologist and whether the lumbar puncture was for a diagnostic or therapeutic purpose? The Correct Coding Initiative bundles these services, but will allow a modifier to explain special circumstances; however, modifiers 62 and 80 are not allowed to be reported with these services. If it was medically necessary to separate the service, your best option may be to report the lumbar puncture with a 59 modifier and documentation to support the separation of bundled services.

The oncologist should submit 96450 (Chemotherapy administration, into CNS [e.g., intrathecal], requiring and including spinal puncture) with a 52 modifier to indicate reduces services and the anesthesiologist will report either 62270 (Spinal puncture, lumbar, diagnostic) or 62272 (Spinal puncture, therapeutic, for drainage of cerebrospinal fluid) for the anesthesia service.