Neurology & Pain Management Coding Alert

Question: Our neurologist performed a spinal tap for a patient who reported to the ED with pain in her legs and a burning sensation. The patient had undergone a spinal surgery about seven days prior to visiting the ED. How do we report this?

Ohio Subscriber

Answer: The ED services are not clear in your question. You may or may not separately report the ED services depending upon what was performed and if it met the criteria for separately identifiable and significant from the spinal tap performed on the same day. Confirm from the clinical note before you report code 99282 (Emergency department visit for the evaluation and management of a patient, which requires these three key components: an expanded problem-focused history; an expanded problem-focused examination; and medical decision making of low complexity …) for the ED services. You report code 62270 (Spinal puncture, lumbar, diagnostic) for the lumbar puncture. Here, your neurologist has a diagnostic intention when performing the spinal tap. You should not need to append modifier 24 (Unrelated evaluation and management service by the same physician during a postoperative period) or modifier 79 (Unrelated procedure or service by the same physician during the postoperative period) with these codes as your neurologist’s services would typically not part of the spinal surgery global period in contrast to that of a neurosurgeon’s.