Table of Contents

Basics about 62270 CPT code (Lumbar Puncture)

A lumbar spinal puncture is performed for diagnostic or therapeutic purposes. A lumbar puncture (spinal tap) is performed in your lower back, in the lumbar region. During a lumbar puncture, a needle is inserted between two lumbar bones (vertebrae) to remove a sample of cerebrospinal fluid. This is the fluid that surrounds your brain and spinal cord to protect them from injury. We have separate CPT code for lumbar puncture in medical coding. CPT code 62270 and 62272 are used for coding lumbar/spinal puncture procedures.

We have learnt about coding spinal injection, which are now bundled with imaging guidance codes. Also, their are other puncture procedures like arthrocentesis, paracentesis, thoracentesis , Fine needle aspiration etc, which involves removal of abnormal fluid from the body.

62270 – Spinal puncture, lumbar, diagnostic;

62328 with fluoroscopic or CT guidance

62272 – Spinal puncture, therapeutic, for drainage of cerebrospinal fluid (by needle or catheter);

62329 with fluoroscopic or CT guidance

Details of CPT code for Lumbar/spinal puncture

CPT code 62270, A diagnostic lumbar puncture, also known as a spinal tap, is performed using anatomical landmarks in 62270 and under fluoroscopic or CT guidance in 62328. The patient is placed in a spinal tap position, either lying on one side or in an upright position. The skin is sterilized and a local anesthetic may be administered. The biopsy needle is inserted and cerebrospinal fluid (CSF) is withdrawn for diagnostic testing. Upon completion of the procedure, the needle is removed and a small sterile dressing is applied to the wound.

CPT code 62272, A therapeutic spinal puncture is performed to lessen cerebrospinal fluid pressure. The patient is placed in a spinal tap position. Using anatomical landmarks (62272) or fluoroscopic or CT guidance (62329), usually the L3 and L4 vertebrae are located and local anesthesia is administered. The lumbar puncture needle is inserted.

In some cases, spinal fluid is drawn through the needle as in a lumbar puncture test. In other cases, a catheter is inserted and the fluid empties into a reservoir. Pressure reading is performed with a manometer. When the procedure is completed, the needle is removed and the wound is dressed. In many cases, the patient lies prone to prevent fluid leakage.

Indications for Lumbar/spinal puncture

Fluoroscopic guidance for LP may be required for the following reasons:

failed attempts without imaging
for patients who have difficult anatomy due to obesity, prior spine surgery or other reasons

Indications for Lumbar Puncture, in general, include :

CSF sampling
opening pressure measurements
administration of intrathecal chemotherapy
administration of contrast (e.g. CT myelography, nuclear medicine CSF leak studies)

Do and Don’t

Do assign code 62270 for diagnostic lumbar puncture, when performed without imaging guidance, or with ultrasound or MRI imaging guidance.
Do assign code 62272 for therapeutic lumbar puncture when a catheter is placed for CSF leak, when performed without imaging guidance, or with ultrasound or MRI imaging guidance.
Do assign code 62272 for therapeutic lumbar puncture when a needle is placed into the thecal sac and 50-60 cc CSF is removed to treat pseudotumor cerebrii (without imaging guidance, or with ultrasound or MRI imaging guidance).
Do assign code 62328 when diagnostic lumbar puncture is performed with fluoroscopic or CT guidance (which is bundled).
Do assign code 62329 when therapeutic lumbar puncture is performed with fluoroscopic or CT guidance (which is bundled).
Do not submit any additional code if CSF is removed via the same access at the time of lumbar puncture for myelography or CT. This is included in codes 62302-62305, 62284, and 61055.
When necessary, report code 76942 for ultrasound guidance or 77021 for MRI guidance in addition to CPT code 62270 and 62272.
Do not report codes 77003 and 77012 with lumbar puncture CPT code 62270 and 62272, as fluoroscopic and CT imaging guidance are bundled with codes 62328 and 62329.

Imaging Guidance used with Lumbar puncture CPT code 62270

Do not report CPT code 62270, 62272 62328, 62329 in conjunction with CPT code 77003, 77012

Fluoroscopic guidance is used to locate the target site for inserting a needle or catheter tip for spinal or paraspinous diagnostic or therapeutic injection procedures. Fluoroscopy is a continuous, x-ray beam passed through the body part being examined and projected onto a TV-like monitor to create a kind of x-ray movie. This uses more radiation than standard x-rays and can image many different body systems to locate a specific structure or organ, as well as study movement within the body.

The needle or catheter tip is inserted and a small amount of contrast material is injected and observed fluoroscopically to ensure correct positioning for an injection. The separately reportable primary injection procedure may be performed for diagnostic or therapeutic purposes, including injection of an anesthetic, a steroid, or destruction by neurolytic agent.

Under fluoroscopic guidance, the physician monitors the injection procedure as it is carried out and provides a written report of the radiological component of the procedure.

96450 – Chemotherapy administration, into CNS (eg, intrathecal), requiring and including spinal puncture

When one or a combination of antineoplastic drugs is injected into the central nervous system, then this procedure is referred to as intrathecal chemotherapy. The skin over the lumbar spine is disinfected and a local anesthetic is administered. A lumbar puncture needle is then inserted into the spinal canal. CSF specimens are collected as needed. A spinal catheter is advanced through the lumbar puncture needle.

The antineoplastic drugs are then injected into the spinal fluid in the spinal canal. The spinal fluid containing the antineoplastic drugs then circulates around the spinal canal and brain delivering the drugs to the central nervous system. Upon completion of the procedure, the spinal catheter is removed and pressure is applied at the puncture site as needed.

A one more similar procedure code 96542 is use for chemotheraphy injection in subarachnoid or intraventricular via subcutaneous reservoir.

96542– Chemotherapy injection, subarachnoid or intraventricular via subcutaneous reservoir, single or multiple agents

Spinal fluid obtained from the lumbar puncture can be used to diagnose many important diseases such as bleeding around the brain; increased pressure from hydrocephalus; inflammation of the brain, spinal cord, or adjacent tissues (encephalitis, meningitis); tumors of the brain or spinal cord, etc.

Modifiers used CPT code for Lumbar Puncture (incomplete exam)

The AMA provides the following two modifiers to indicate that any procedure (including lumbar puncture) is incomplete, reduced or discontinued:

Modifier -52. Use this code to report services that are partially reduced or eliminated at your election. Make sure your documentation explains the circumstances that led you to stop the procedure before it was complete.

Modifier -53. Use this code when you discontinue because the patient’s life is endangered. CPT says you should use this modifier only when you have already prepped and anesthetized the patient.

Supply and Equipment codes used with Lumbar puncture CPT codes

SA048 pack, minimum multi-specialty visit
SA065 tray, lumbar puncture
SB001 cap, surgical
SB012 drape, sterile, for Mayo stand
SB024 gloves, sterile
SB027 gown, staff, impervious
SB028 gown, surgical, sterile
SB033 mask, surgical
SB044 underpad 2ft x 3ft (Chux)
SC048 spinal manometer

EF023 table, exam

Additional Code Information CPT code 62770 & 62272

PC/TC Indicator (26): 0 = Physician Service Codes

Multiple Procedures (51): 2 = Standard payment adjustment rules for multiple procedures apply

Bilateral Surgery (50): 0 = 150% payment adjustment for bilateral procedures does not apply

Physician Supervision: 09 = Concept does not apply

Assistant Surgeon (80,82): 1 = Statutory payment restriction for assistants at surgery applies to this procedure

Co-Surgeons (62): 0 = Co-surgeons not permitted for this procedure

Team Surgery (66): 0 = Team surgeons not permitted for this procedure

Diagnostic Imaging Family: 99 = Concept does not apply

Hope, all these information will increase you knowledge about CPT code for lumbar puncture, if you really like the article do share it.

Best Coding tips for CPT code 62270 & 62272 (Lumbar Puncture)