Question: What do I need to know to bill for a lumbar puncture?
Answer: There are two types of lumbar puncture (LP) codes: diagnostic and therapeutic. When done for diagnosis, choose Current Procedural Terminology (CPT) 62270 (2.25 Relative Value Units [RVUs], $81.11 Medicare). When the diagnosis is already known and the LP is performed for therapeutic drainage reasons, CPT 62272 (2.43 RVUs, $87.60 Medicare) is the correct code choice. Another spinal injection code, CPT 62273, is available for epidural blood patch.
Explore This IssueACEP Now: Vol 38 – No 09 – September 2019
When documenting the LP procedure, note the position of the patient, site of entry, preparation technique, and any findings. It is also advisable to document the attempt even if it was unsuccessful, as these can be billed with the appropriate modifiers (eg, -52 or -53). Note the reason the procedure was unsuccessful, and document how much of the procedure was completed prior to termination. Especially note if a patient requested you stop the procedure, as this is a relevant distinction from being otherwise unable to obtain a sample.
When you use ultrasound to assist in needle placement and images are saved, this can be billed separately as CPT 76942 (0.67 RVUs, $24.15 Medicare). Not all insurance providers will reimburse this as a separate procedure, so you should check with your local payers to see if this additional code is of value.
Brought to you by the ACEP Reimbursement Committee.
Dr. Pasichow is an emergency medicine resident at Rhode Island Hospital in Providence.