Neurosurgery Coding Alert

Question: The neurosurgeon completed L5 laminectomy on a patient. Two weeks later, the patient presented to the Emergency Department with burning lower extremity pain, perineal numbness, and difficulty urinating. The neurosurgeon was brought in and completed a lumbar puncture while the patient was still in the ED. How should we code the ED services?

Florida Subscriber

Answer: Assuming the problem is unrelated to the initial surgery, you'll report the ER visit and lumbar puncture, plus the appropriate modifiers.

Begin with 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 decisionmaking of low complexity ...). Append modifier 24 (Unrelated evaluation and management service by the same physician during a postoperative period) to 99282 because the service is for a new problem during the laminectomy's global period.

Report the lumbar puncture with 62270 (Spinal puncture, lumbar, diagnostic). Append modifier 79 (Unrelated procedure or service by the same physician during the postoperative period) to 62270 to indicate the lumbar puncture is unrelated to the original laminectomy.

Technical and coding guidance for You Be the Coder and Reader Questions provided by Gregory Przybylski, MD, director of neurosurgery at the New Jersey Neuroscience Institute, JFK Medical Center in Edison.