Lumbar puncture reporting can become quite challenging when your physician either takes longer than usual with a difficult puncture or decides to discontinue part of the procedure. Read on to know how you can take the pain out of your work.
Ask yourself these modifier questions, whether you’re reporting reduced or difficult punctures or punctures done during global periods.
Is it a Reduced Procedure? Modifier 52 is the Choice
|Neurology and Pain Management Coding Alert Are incorrect modifiers ripping you of your reimbursement? Get the most practical, airtight solutions to your modifier woes with Neurology And Pain Management Coding Alert. Click here to buy.|
If your physician or the patient may elect to perform only part of the procedure instead of the entire puncture, you append modifier 52 (Reduced services) to 62270 (Spinal puncture, lumbar, diagnostic) or 62272 (Spinal puncture, therapeutic, for drainage of cerebrospinal fluid [by needle or catheter]) to imply the reduced (not terminated) puncture.
“You would report the reduced procedure with a modifier 52, which means that the procedure was partially performed to treat the patient. The physician should also expect a reduced payment for this procedure,” says Teresa Thomas, BBA, RHIT, CPC, practice manager II at St. John’s Clinic (Neurosurgery) in Springfield, Mo.
“A reduced procedure means that the service did not include all of the required elements because of a ‘choice,’ usually because the entire service was not needed,” explains Rena Hall, CPC, a biller and coder with Kansas City Neurosurgery Group in Kansas City, Mo. “This reporting option would be extremely uncommon, as other modifiers would likely better describe the incomplete service performed.”
Example: Some coders might consider applying the 52 modifier...
- Free updates on CPT, ICD-9, HCPCS, Medicare, NCCI edits, and ICD-10.
- Discounts on 3rd party offers