Wednesday, November 9, 2016

CPT code 62270, 62272, 62273 - Lumbar Puncture

Lumbar puncture Procedure code and Description

62270 T Spinal puncture, lumbar, diagnostic 0206 $373 $204

62272 T Spinal puncture, therapeutic, for drainage of cerebrospinal fluid (by needle or catheter) 0206 $373 $204

62273 T Injection, epidural, of blood or clot patch 0207 $672 $368


What is a Lumbar Puncture?

Fluoroscopy is a special form of X-ray that produces real-time video images, as opposed to pictures on film, making it possible to see internal organs and joints in motion. A lumbar puncture (also called a spinal tap) is a fluoroscopic procedure used to collect and look at the cerebrospinal fluid (CSF) surrounding the brain and spinal cord.


A lumbar puncture can help diagnose serious infections, such as

• Meningitis;

• Other disorders of the central nervous system, such as Guillain-Barre syndrome and multiple sclerosis;

• Cancers of the brain or spinal cord.

Sometimes doctors use lumbar puncture to inject anesthetic medications or chemotherapy drugs into the cerebrospinal fluid.

Other names for a lumbar puncture (an LP):
• Spinal tap
• Spinal puncture
• Thecal puncture (thecal sac is a membrane of dura mater that surrounds the spinal cord and the cauda equina)
• Rachiocentesis (prefix “rachio-” indicating “spine”)

Other spinal punctures or punctures to obtain cerebral spinal fluid (CSF):

• Ventricular puncture (this is a puncture into a lateral ventricle of the brain)
• Cisternal puncture (this is a cervical vertebral puncture into the  cisterna at the base of the brain)


Spinal Injection Procedures that May Be Done Without Fluoroscopy Interlaminar epidural steroid injections may be performed without fluoroscopy if performed at a certified or accredited facility by a provider with privileges to perform the procedure at that facility. The provider must decide whether to use fluoroscopy based on sound medical practice. To be payable, these spinal injections must include a facility place of service code and documentation that the procedure was performed at a certified or accredited facility. Procedure  Code 62310 62311 62318 62319

Spinal Injection Procedures that Don’t Require Fluoroscopy Procedure  Code 62270 62272 62273


CPT 62273 - injection, epidural, of blood or clot patch; a comprehensive code, includes the following component codes:

• 36000 introduction of needle or intracatheter, vein
• 36140 introduction of needle or intracatheter, extremity artery
• 36410 venipuncture, child over age 3 years or adult, necessitating physician’s skill
• 62310 injection, single, epidural or subarachnoid; cervical or thoracic
• 62311 injection, single; epidural, lumbar sacral (caudal)
• 64479 transforaminal epidural; cervical or thoracic, single level
• 64483 transforaminal epidural; lumbar or sacral, single level
• 69990 use of operating microscope
• 76000-76003 fluoroscopy codes
• G0001 routine venipuncture for collection of specimen(s)


Code 62273 has been revised by deleting the specific reference to the lumbar region of the spine, because an ongoing cerebrospinal fluid leak can occur at any level of the spinal column. This revision clarifies that the epidural injection of blood or blood clot is not limited to the lumbar region.

Codes 62274 to 62279 have been deleted to eliminate overlapping procedures, accommodate placement of new combinations of procedures and substances (eg, injection of local anesthetic and steroid), designate types of administration, and specific spinal anatomy. Cross-references appear in the 2000 CPT book in the Spine and Spinal Cord Section to direct clinicians to the appropriate new injection procedure codes.

Anesthesia Service Codes not an all-inclusive list

Procedure  Code - 00100 to 00936, 00940 to 01999, 62273, 99100 to 99150

HCPCS Code - D9220, D9221 (D-codes only covered for oral surgery)

Anesthesia Modifiers *not an all-inclusive list. See Modifier policy for a complete list Modifiers must be billed with anesthesia procedure codes to indicate whether the procedure was personally performed, medically directed or medically supervised.

Service will deny:

* When billed without appropriate modifier for provider’s specialty

* When modifier is not billed in the appropriate modifier position.

* When billed with invalid modifier combinations. (see incorrect modifier billing  combination grid below)

* If not billed in accordance with standard coding/billing guidelines and Neighborhood’s policies


Image Guidance: 77003 Fluoroscopy Image Guidance: Guidance: 77003 Fluoroscopy Fluoroscopy * Spine and Spinal Cord: Injection, Drainage, or Aspiration Procedure  Section Guidelines

– Injection of contrast during fluoroscopic guidance and localization is an inclusive component in 62263, 62264, 66267, 62270-62273, 62280-62282, 62310- 62319.



A second issue relates to the reimbursement schedule. Most of the interventional procedures are grouped into Group II, diagnostic and therapeutic procedures with therapeutic procedures being reimbwsed at 7 5o/o of the applicable group rates of $130.00 and other diagnostic procedures at $168.00.

The following procedures are either listed in Group II C or D:

Procedure  62273 - injection, epidural, ofblood or clot patch

Procedure  62281 - injection/infusion of neurolytic substance, with or without other therapeutic substance; epidural, cervical or thoracic

Procedure  62282 - injection/infusion of neurolytic substance, with or without other therapeutic substance; epidural, lumbar, sacral (caudal)

Procedure  6231,0 - injection, single, not including neurolytic substances, with or without contrast, of diagnostic or'therapeutic substances; epidural or subarachnoid; cervical or thoracic

Procedure  62311 - - injection, single, not including neurolytic substances, with or without contrast, of diagnostic or therapeutic substances; epidural or subarachnoid; lumbar, sacral (caudal)


Billing Fluorscopic Guidance In Conjunctions with Facet Joint Injections 

Since fluoroscopic guidance is required to perform paravertebral facet joint and paravertebral facet joint nerve with destruction by neurolytic agent or sacroiliac joint injections, code 77003 should be additionally reported in conjunction with codes 64470- 64476, 64479-64484 and 64622-64627; and in certain circumstance, with code 27096.

Subsequent CPT Assistant articles in the January and February 2000 issues repeated the critical language “code 77003 should be additionally reported” when fluoroscopic guidance and localization is performed in conjunction with the epidural, subarachnoid, transforaminal, facet joint and paravertebral facet joint injections.

The Director of CPT Information and Education Services confirmed that “…from a CPT coding perspective code 77003 should be separately reported in addition to codes 62270-62273, 62280-62282, 62310-62319, and 64470-64484.”

Failure to report the fluoroscopic guidance code may result in the recoupment of claims for facet injections.



Neurology/Spine Surgery

The spinal and spinal cord injection codes reflect the specific spinal anatomy, such as subarachnoid or epidural; the level of the injection (cervical, thoracic, lumbar, or sacral); and the types of substances injected, such as anesthetic steroids, antispasmodics, phenol, etc.

Injection of contrast material during fluoroscopic guidance is included in codes 62263–62264, 62267, 62270–62273, 62280–62282, and 62310–62319. The fluoroscopic guidance itself is reported by code 77003. Code 62263 describes treatment involving injections of various substances over a multiple-day period. Code 62263 is not reported for each individual injection but is reported once to describe the entire series of injections or infusions.

Code 62264 describes multiple treatments performed on the same day.

Other codes in this section refer to laminectomies, excisions, repairs, and shunts. A basic distinction among the codes is the condition, such as herniated disk, as well as the approach used, such as anterior or posterior or costovertebral.

Lumbar punctures (62270) are also called spinal taps and are used to obtain cerebrospinal fluid by inserting a needle into the subarachnoid space in the lumbar area.

When coding surgery on the spine, there are many sets of guidelines for the coder to review, including those at the beginning of the subsection, as well as throughout the subsection.

Co-surgery is common in spinal surgeries. When two surgeons work together, both as primary surgeons, each surgeon should report his or her distinct operative work by adding modifier - 62 to the procedure code and any associated add-on codes for that procedure as long as both surgeons continue to work together as primary surgeons.

Spinal instrumentation is used to stabilize the spinal column during repair procedures. There are two types: segmental and nonsegmental.

• Segmental instrumentation involves attachment at each end of the spinal area and at least one intermittent fixation.

• Nonsegmental instrumentation involves attachment at each end and may span several vertebral segments without intermittent fixation.

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