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Lumbar Puncture For Myelogram and Cisternogram

Leorah Posted Thu 05th of March, 2020 03:39:10 AM
Our doctors performed a lumbar puncture for myelogram into 2 or more regions and a cisternogram for a CSF Leak. What do I code? Thank you
SuperCoder Answered Fri 06th of March, 2020 05:41:56 AM



As per the given report, the appropriate CPT code will be 78630, 62305, 62270-59.


Note: A cisternogram demonstrates the flow and track of CSF around the head. The test checks for leaks of CSF out of the body, through the nose, for instance, and also helps diagnose a brain condition known as NPH, normal pressure hydrocephalus. The appropriate code to describe this procedure is 78630 (Cerebrospinal fluid flow, imaging [not including introduction of material]; cisternography) for the radiological side.

Depending on site of the puncture, use the appropriate code from 61000–61070 or 62270–62294 to report the injection portion of the procedure.



Leorah Posted Sun 08th of March, 2020 09:49:47 AM
With a lumbar puncture I usually code 62270 and a 77003. I shouldn't include the 77003 this time?
SuperCoder Answered Mon 09th of March, 2020 03:14:17 AM



Thanks for the question.


If the provider uses fluoroscopic guidance during the injection procedures, use 62328.

From 1, Jan 2020, AMA created a new code 62328 (Spinal puncture, lumbar, diagnostic; with fluoroscopic or CT guidance), CPT 77003 is inclusive in 62328 and cannot be coded separately.

If above mentioned procedure has been performed In CY 2019 then appropriate code will be 62270 and 77003 for spinal puncture with fluoroscopic guidance.


It suggested please check DOS of the claim and code accordingly.


As per CY 2020 guidelines, do not report 62270, 62328 in conjunction with 77003, 77012. If spinal puncture (lumbar) is performed without fluoroscopic or CT guidance, code with 62270. If spinal puncture (lumbar) is performed with fluoroscopic or CT guidance, code with 62328.


Hope this helps!



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