Other reaction to spinal and lumbar puncture. 2016 2017 2018 2019 Billable/Specific Code. G97.1 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. The 2019 edition of ICD-10-CM G97.1 became effective on October 1, 2018.
Your radiologist and oncologist need to discuss this situation and come to a decision about who will bill. The appropriate code is 96450 - intrathecal chemotherapy injection - and it includes the spinal puncture. If the oncologist bills 96450 and the radiologist bills 62270 or 62272, then the patient is being double billed for the spinal puncture.
Unless a lumbar puncture was obtained for diagnostic purposes from a separate puncture site the only code that you could use is the guidance (usually 77003) as the 62270 is bundled with the methotrexate injection.
Question: What do I need to know to bill for a lumbar puncture? Answer: There are two types of lumbar puncture (LP) codes: diagnostic and therapeutic. When done for diagnosis, choose Current Procedural Terminology (CPT) 62270 (2.25 Relative Value Units [RVUs], $81.11 Medicare).
96450 Chemotherapy administration, into CNS (e.g. intrathecal), requiring and including spinal puncture • Non-timed based service.
Listen to pronunciation. (IN-truh-THEE-kul KEE-moh-THAYR-uh-pee) Treatment in which anticancer drugs are injected into the fluid-filled space between the thin layers of tissue that cover the brain and spinal cord.
G97. 1 - Other reaction to spinal and lumbar puncture. ICD-10-CM.
Intrathecal chemotherapy is given into the fluid around the brain and spinal cord. This is given during a lumbar puncture.
Intrathecal chemotherapy can be given in two ways: Lumbar puncture. A lumbar puncture (spinal tap) is a way to access your spine and deliver the medication to your CSF. It's the same procedure your doctor probably did to test your CSF for cancer cells.
A lumbar puncture is a procedure that involves having a thin needle put into your lower back. You might have a lumbar puncture if your specialist suspects you have lymphoma in your brain or spinal cord (central nervous system or CNS), or if you need to have chemotherapy drugs that reach your CNS.
A lumbar puncture may be performed for diagnostic or therapeutic purposes. Diagnostic lumbar puncture is a procedure which is done to remove a small amount of cerebrospinal fluid for laboratory testing, and is reported with CPT code 62270. A therapeutic lumbar puncture is reported with CPT code 62272.
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.
You'll use 62272 (Spinal puncture, therapeutic, for drainage of cerebrospinal fluid (by needle or catheter) instead.
A healthcare professional will administer intrathecal chemotherapy by injecting it into the spinal canal during a lumbar puncture. They may also administer it through a plastic insert called an Ommaya reservoir, which sits under the scalp.
The intrathecal route allows direct drug administration to the CSF by circumventing the blood-brain barrier. It therefore allows delivery of smaller drug doses and the occurrence of side effects is reduced compared with systemic routes of drug administration (eg, oral, intravenous and epidural).
In children with acute lymphoblastic leukemia and acute myeloid leukemia, doctors at Hassenfeld Children's Hospital at NYU Langone administer targeted chemotherapy drugs during a lumbar puncture to not only kill any cancer cells in the brain and spinal cord but also to prevent new cancer cells from forming.
Intrathecal administration is delivered directly into the CSF and into the superifical spinal cord; epidural administration diffuses through the dura into the CSF, and thus has a slower onset of action.
The process takes about 30 minutes. Afterward, you'll stay still for at least an hour to let the drug move through the intrathecal space. If you need many doses or will get your medicines over a long period, your doctor may suggest an implant so you don't need as many spinal taps.
Intrathecal administration is a route of administration for drugs via an injection into the spinal canal, or into the subarachnoid space so that it reaches the cerebrospinal fluid (CSF) and is useful in spinal anesthesia, chemotherapy, or pain management applications.
Intrathecal methotrexate is given through a needle which is inserted in one of the spaces between the bones in the lower back into the CSF, usually under general anaesthesia. This is known as a lumbar puncture. When drugs are given in this way, they are said to be given intrathecally.
Unless a lumbar puncture was obtained for diagnostic purposes from a separate puncture site the only code that you could use is the guidance (usually 77003) as the 62270 is bundled with the methotrexate injection. It isn't beneficial to the radiologist, however it seems that Radiologists are getting the short end of the stick more ...
"Add code 62270 only if CSF fluid is removed via a separate punture site during the procedure for a diagnostic study. DO NOT CODE 62270 additionally if CSF fluid removal is performed via the initial needle placement used for chemotherapy administration"
This is clearly not a diagnostic LP so , 62270/72 should not be billed for the radiologist. All you have is fluoro (77003). If the onco is injecting, all they should bill for is 96450. I can almost guarantee that both will have to have the case (s) reviewed/appealed when billing to medicare.