Lumbar Punctures and the Continued Bundling of Imaging Guidance

Lumbar puncture, spinal puncture, spinal tap – no matter what we call it the procedure is commonly performed and, with new and revised codes for 2020, multiple options are available when it comes to how they are coded. Let’s review these new and revised codes, what the criteria are for assignment and how the differences in the procedure itself determine proper code selection. By understanding the correct application, you can be confident in your coding throughout the year.

The Procedure

Lumbar punctures are performed by inserting a needle in between two vertebrae in the lower back (lumbar region) to remove cerebral spinal fluid (CSF). The report may document placement of a needle intrathecally, or into the thecal sac, and the removal of fluid. These punctures can be done with or without imaging guidance for either diagnostic or therapeutic reasons.

Diagnostic lumbar punctures are done to collect CSF for the lab to perform diagnostic studies. With therapeutic lumbar punctures, the intent of the procedure is not to aid in diagnosis but to withdraw CSF for the purposes of relieving pressure. When coding, it is important to understand if the spinal puncture was performed for diagnostic or therapeutic reasons as it will impact code selection.

One question we receive regarding therapeutic spinal punctures is:

  • Is there a certain amount of CSF that needs to be removed for the procedure to be considered therapeutic?

The answer is no, there is no current guidance (that we are aware of) that sets an amount of CSF removed for the procedure to be therapeutic. As with other areas, it depends on what the intent of the procedure was. If the intent was to drain fluid, for reasons other than diagnostic, the procedure would be considered therapeutic.

The Codes

How lumbar punctures are coded will depend on the intent of the procedure (diagnostic or therapeutic), whether or not imaging guidance was used and the type of imaging guidance. Most often, lumbar punctures are performed with either fluoroscopic or CT guidance, which resulted in these imaging guidance modalities being bundled into two new codes as of January 1.

62328Spinal puncture, lumbar, diagnostic; with fluoroscopic or CT guidancel
62329Spinal puncture, therapeutic, for drainage of cerebrospinal fluid (by needle or catheter); with fluoroscopic or CT guidance

For procedures performed without imaging guidance, or with ultrasound or MR guidance, we would use these codes instead:

62270Spinal puncture, lumbar, diagnostic;
62272Spinal puncture, therapeutic, for drainage of cerebrospinal fluid (by needle or catheter)

These codes do not mention imaging guidance, so, if used, the ultrasound or MR guidance would be separately coded with the appropriate guidance codes – 76942 for ultrasound and 77021 for MR.

Imaging GuidanceDiagnostic Code(s)Therapeutic Code(s)
Ultrasound62270, 7694262272, 76942
MR62270, 7702162272, 77021

When determining the proper code, knowing the intent of the procedure, whether or not imaging guidance was used and what type of imaging guidance will ensure accurate code selection.

It is important to note that a spinal puncture may be performed as part of a larger procedure. When performed as part of, or to facilitate, another procedure the puncture is not separately coded except in very specific instances, so be sure to read those parenthetical notes to determine if separately reporting the puncture is an option – or if it would result in unbundling.