Published in the February 2005 issue of Today’s Hospitalist
Do you know how to properly code for a lumbar puncture in the inpatient setting, particularly one that is incomplete?
When patients present with headache, neck pain and fever of unknown etiology, you may perform a lumbar puncture to rule out meningitis. There are some interesting points to remember when performing this procedure within the inpatient setting.
In this month’s article, I’ll focus on general coding issues and how to use modifiers when billing for a lumbar puncture.
A bad draw
According to the “The Coder’s Desk Reference,” CPT 62270 requires physicians to take several actions. You place the patient in spinal tap position, insert the biopsy needle and draw fluid for a separately reportable test. Once the procedure is complete, you remove the needle and dress the wound.
What happens, however, if you perform a lumbar puncture that doesn’t produce the desired outcome? For instance, what happens if you draw blood instead of spinal fluid?
You might be surprised at how many physicians assume that they can’t use CPT 62270 because they haven’t met the requirements of the code in the above scenario. Review the above description of a lumbar puncture, however, and you’ll realize that you have in fact performed the procedure in its entirety. In other words, it is appropriate to bill CPT 62270.
Consider another scenario: You are attempting to perform a lumbar puncture, and the patient begins to experience respiratory difficulties. After some consideration, you decide to terminate the procedure to avoid causing any harm to the patient.
The AMA provides the following two modifiers to indicate that any procedure (not just a 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.
Note that when you use either of the above modifiers, you should expect payers to reduce the normal and customary payment because the procedure was not carried out in its entirety.
E/M and critical care services
Due to the complexity of most patients in the inpatient setting, it would not be uncommon to bill for an evaluation and management service together with a lumbar puncture.
Note, however, that you’ll have to use a -25 modifier with the E/M service to indicate that you’ve performed a significant and separately identifiable E/M service on the same day of a procedure.
It’s also acceptable to bill for critical care services that you perform in the same encounter as a lumbar puncture. To calculate the time you bill for critical care services, remember to deduct the amount of time you spend performing the lumbar puncture and any other separately billable charges.
The bottom line? Consider the steps required to meet the definition of the procedure, and don’t use any unnecessary modifiers simply because the procedure did not yield the desired end result. You could be substantially cutting revenue that is rightly yours.
Tamra McLain can be reached through e-mail. Send her your questions to be answered in future issues of Today’s Hospitalist.