Neurology & Pain Management Coding Alert

Question: We've decided to provide lumbar punctures in the office instead of in the hospital. How should we bill for this? I assume that in addition to the E/M service and the puncture, we would also bill for the supplies and the observation after the procedure. Is this correct?

Neurology Discussion Group Participant

Answer: Report the lumbar puncture (LP) using 62270* (Spinal puncture, lumbar, diagnostic) or, if appropriate, 62272* (Spinal puncture, therapeutic, for drainage of cerebrospinal fluid [by needle or catheter]). If the physician provides a separate, significant E/M service, you may report it at the level supported by documentation. Be sure to 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 the E/M service code, or the payer will bundle the E/M code to the puncture and refuse separate reimbursement.

Note: Several readers have reported difficulty receiving separate reimbursement for LP and an E/M service unless they append modifier -57 (Decision for surgery) to the E/M service code. Note that 62270/62272 have a zero-day global period, so modifier -25, not -57, is appropriate. If the payer rejects your claim and says that modifier -25 is incorrect, appeal.

Appropriate billing for supplies depends on your payer. Medicare allows local carriers jurisdiction in this case, and some Medicare payers will not reimburse separately for LP trays. Of those payers who will reimburse for the supplies (Medicare and private), some specify that the provider bill using A4550 (Surgical trays), while others prefer 99070 (Supplies and materials [except spectacles], provided by the physician over and above those usually included with the office visit or other services rendered [list drugs, trays, supplies or materials provided]). Check with your payer for its guidelines and, in either case, attach an invoice for the tray so the payer is aware of the cost.

Generally, the patient remains in the office for observation for about an hour following LP. You cannot bill separately for this, but the practice-expense relative value units assigned to 62270/62272 are slightly higher for a nonfacility setting, raising reimbursement above the level provided if the physician performs the LP in the hospital or other facility setting.