Neurology & Pain Management Coding Alert

Question: What is the difference between lumbar puncture codes 62270 (spinal puncture, lumbar, diagnostic) and 62288 (injection of substance other than anesthetic, antispasmodic, contrast, or neurolytic solutions; subarachnoid [separate procedure])?

Anonymous Maine Subscriber

Answer: In some ways, these codes could be said to describe procedures that are directly opposite one another.

A neurologist would use 62270 when he or she draws spinal fluid from a patient for diagnostic purposes. This procedure most likely would be performed to confirm or rule out meningitis, to determine if there is blood in the spinal fluid following trauma, or to pinpoint other possible infections. Historically, on the other hand, code 62288 has been assigned when the physician injects a substance into the spine to treat an infection or other condition.

Coders should note, however, that 62288 has been eliminated from CPT 2000. Two new codes, both describing injections in greater detail, have been added in its place:

- 62310: injection, single (not via indwelling catheter), not including neurolytic substances, with or without contrast (for either localization or epidurography), of diagnostic or therapeutic substance(s) (including anesthetic, antispasmodic, opioid, steroid, other solution), epidural or subarachnoid; cervical or thoracic.

- 62311: lumbar, sacral (caudal)

In CPT 1999, code 62288 did not clearly state that it should be used only for a single injection and did not define what area of the back received the injection. These issues have been explained better in CPT 2000.