Focusing on three areas related to diagnostic lumbar punctures and similar procedures will help you code these claims correctly, even though determining the best anesthesia code for them has challenged coders for years. CPT Codes 2001's addition of CPT 00635 (Anesthesia for procedures in lumbar region; diagnostic or therapeutic lumbar puncture) helped the situation but didn't cure it. Some carriers are slow to accept new codes, and a growing number of anesthesiologists perform the procedure represented by 00635 themselves.
Coding Depends on the Anesthesiologist's Role in the Procedure
One of the biggest challenges associated with billing for lumbar punctures is determining whether you should bill the service as an anesthesia charge or as a flat-fee surgical charge, says Tonia Raley, CPC, claims manager for the medical billing firm Medical Information Systems in Phoenix. "Anesthesiologists are asked to perform these procedures fairly often, as they have had extensive training in placement and management of these types of procedures," she explains.
Anesthesiologists perform most diagnostic lumbar punctures under a local anesthetic rather than general anesthesia, Raley says. If the physician performs the puncture under a local anesthetic, he or she is the only one present. Because the professional performing the spinal tap is usually able to provide adequate local anesthesia for the procedure, you should only bill the procedure no separate fee for anesthesia because none was given. But if special circumstances apply (such as treatment of children, severely mentally retarded adults or patients with delirium) and your group administers an anesthetic as well as performs the procedure, two physicians must be present during the procedure one to perform the lumbar puncture and the other to provide monitored anesthesia care (MAC) or general anesthesia.
In that scenario, bill with the appropriate anesthesia code for the physician providing anesthesia (see below for example codes), along with type-of-service "07" for "anesthesia services." The anesthesiologist who performs the procedure bills it as a flat-fee service (otherwise known as a surgical service) with the appropriate CPT code and type-of-service "02" for "surgical procedure." (Insurance forms include a key designating the different types of service, so you can place the appropriate number in the form's type-of-service box.)
Know All Your Coding Options
Once you know whether you should code the physician's services as an anesthesia provider or the performing surgeon, yet another question arises: Which coding source does the carrier base its reimbursement on? Does it use the ASA Relative Value Guide, the ASA Crosswalk, or anesthesia codes rather than the surgical codes listed in CPT?
If the anesthesiologist performs the puncture, two CPT procedure codes apply: 62270* (Spinal puncture, lumbar, diagnostic) [...]