Neurology & Pain Management Coding Alert

Question: What is the proper code for a spinal tap? The service is usually coupled with a consult or associated with a follow-up.

Neurology Discussion Group Participant

Answer: The proper code to report spinal tap is 62270* (Spinal puncture, lumbar, diagnostic) or 62272* (Spinal puncture, therapeutic, for drainage of cerebro-spinal fluid [by needle or catheter]), as appropriate to the purpose of the tap.

Note that these are "starred" codes, which, according to CPT, include only the procedure itself. Therefore, you may report any accompanying E/M service (e.g., 99242, Office consultation for a new or established patient ...) separately and expect full reimbursement for both codes.

To differentiate the separately identifiable nature of the E/M service, however, you must append modifier -25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to any E/M code reported. Per CMS guidelines, you may apply the same diagnosis, if applicable, to both the spinal puncture and the E/M service.