Neurology & Pain Management Coding Alert

Question: How should I bill for a lumbar puncture that was both diagnostic and therapeutic?

Idaho Subscriber

Answer: CPT includes 62270 (Spinal puncture, lumbar, diagnostic) for a diagnostic lumbar puncture, and 62272 (Spinal puncture, therapeutic, for drainage of cerebrospinal fluid [by needle or catheter]) for a therapeutic puncture. Which code you report depends on your physician's documentation and whether he performed one or two punctures.

One-puncture option: If the documentation shows that your neurologist performed one lumbar puncture for both diagnostic and therapeutic purposes, you should only report one code. Choose 62272 because of its higher level of RVUs.

Separate sticks: If your physician performed two punctures, you can report separate services. Append modifier 59 (Distinct procedural service) to 62270, and then report 62272 on a separate line.

Explain it: Be sure the documentation clearly defines the medical necessity for each puncture, particularly the diagnostic. Include the diagnosis, date and time on the notes for the diagnostic puncture. Once you receive results from the diagnostic procedure, reference the results and write another note with the date, time and reason for the therapeutic intervention. Submit the notes for both punctures when you file the claim.

Note: These coding guidelines only apply if your neurologist administered both lumbar punctures on the same day. If he performed the punctures on separate days, use separate codes.