Radiology Coding Alert

Question: What code do I assign with the following report: Our radiologist performed the lumbar puncture, but an oncologist administered the chemotherapy using the spinal needle our physician placed. "A lumbar puncture is performed, access was obtained to the thecal sac with a spinal needle, and there was spontaneous return of cerebral spinal fluid. 2 cc of spinal fluid in three separate vials were sent to the lab for further analysis."

New Mexico Subscriber

Answer: The administration of the chemotherapy is reported with 96450-52 (Chemotherapy administration, into CNS [e.g., intrathecal], requiring and including spinal puncture) by the physician who performed the service (in this case the oncologist). Because 96450 includes the lumbar puncture, modifier -52 (Reduced services) is required if a second physician performed the lumbar puncture itself. The radiologist should report 62270* (Spinal puncture, lumbar, diagnostic) with no modifier, because the radiologist performed the entire puncture procedure as CPT describes. If fluoroscopic monitoring and guidance was used, the radiologist should also report 76005 (Fluoroscopic guidance and localization of needle or catheter tip for spine or paraspinous diagnostic or therapeutic injection procedures [epidural, transforaminal epidural, subarachnoid, paravertebral facet joint, paraver-tebral facet joint nerve or sacroiliac joint], including neurolytic agent destruction), if documented.