Neurosurgery Coding Alert

Question: Can we bill 62272 (Spinal puncture, therapeutic, for drainage of cerebrospinal fluid [by needle or catheter]) when a dural leak occurs during spine surgery? The durotomy was caused during the surgery. The lumbar drain was placed though a separate stab incision because the CSF leak was repaired and the surgeon still saw some CSF leaking despite the repair. Though the dural leak is incidental to the primary procedure, our neurosurgeon thinks it should be billed because it was placed after the procedure was done. Please help.

New Jersey Subscriber

Answer: While the dural repair is considered incidental to the spinal surgery and is not separately reportable, the placement of the lumbar drain, if performed through a separate site outside of the surgical exposure, would be separately reportable with the 59 (Distinct procedural service) modifier. This is analogous to placement of a separate site ventriculostomy when performing a craniotomy.