Spinal puncture, lumbar, diagnostic
Audit Defense & Denial Intelligence
Research-based denial patterns from OrbDoc Bill Analyzer
1. Insufficient indication - chronic headache without red flags warranting lumbar puncture
Very Common62270 (lumbar puncture) denials occur when indication is vague or doesn't meet medical necessity. 'Chronic headache' alone is insufficient - must have red flags suggesting serious pathology (sudden onset, worst headache of life, neurologic deficits, fever, immunocompromised) or specific diagnostic need (suspected MS, meningitis, SAH after negative CT).
Common Causes
- • Chronic migraines - LP not indicated for routine migraine diagnosis
- • Headache without fever, meningismus, neurologic signs
- • Normal brain CT/MRI - LP rarely adds diagnostic value
Resolution Strategy
Appeal with specific diagnostic indication: suspected meningitis (fever, neck stiffness, altered mental status), subarachnoid hemorrhage workup (sudden severe headache with negative CT - LP looking for xanthochromia), multiple sclerosis evaluation (MRI lesions + LP for oligoclonal bands), pseudotumor cerebri (papilledema on exam + LP for opening pressure), Guillain-Barré syndrome (ascending weakness + LP for albuminocytologic dissociation). If primary headache disorder without red flags, LP not indicated and appeal unlikely to succeed. Imaging (MRI brain) and clinical evaluation usually sufficient for headache workup.
2. CT brain not performed before LP - risk of herniation if mass lesion present
CommonStandard of care requires brain imaging (CT or MRI) before lumbar puncture in most cases to rule out mass lesion or elevated intracranial pressure that could cause herniation with CSF removal. Denials occur when LP performed without prior imaging documentation.
Common Causes
- • LP performed emergently for suspected meningitis without CT first (acceptable if no focal neurologic signs)
- • No documentation that CT brain was performed and reviewed
- • CT performed but report not submitted with claim
Resolution Strategy
Submit brain imaging documentation with appeal: CT or MRI report showing no mass lesion, no midline shift, no obstructive hydrocephalus. For emergent cases (suspected bacterial meningitis), appeal arguing time-critical situation where benefits of rapid diagnosis outweigh small herniation risk, and patient had no contraindications to LP (no focal neurologic deficits, no papilledema, normal mental status). If CT clearly shows mass lesion or elevated ICP, LP was contraindicated and denial appropriate. If imaging normal and documented, appeal should succeed.
3. Therapeutic LP (CSF drainage) performed - should use 62272 instead of diagnostic 62270
Occasional62270 is diagnostic LP (obtaining CSF sample for testing). 62272 is therapeutic LP (removing CSF to reduce intracranial pressure). If primary purpose was CSF pressure reduction (pseudotumor cerebri treatment, normal pressure hydrocephalus challenge), different code required.
Common Causes
- • Pseudotumor cerebri large-volume CSF removal for symptom relief - therapeutic, not diagnostic
- • NPH tap test (removing 30-40ml CSF to see if symptoms improve) - therapeutic
- • Opening pressure very high (>30 cm H2O) and large volume removed - therapeutic intent
Resolution Strategy
Review LP procedure note. If only small volume CSF removed for diagnostic tests (cell count, protein, glucose, culture) = 62270 appropriate. If large volume removed (>20-30ml) for therapeutic purpose (pseudotumor cerebri treatment, NPH tap test to assess gait/cognition improvement) = recode to 62272 and resubmit. If both diagnostic and therapeutic (obtained studies AND removed large volume for pressure reduction), 62272 more appropriate code since therapeutic intent was primary. Include opening and closing pressures, volume removed, and therapeutic intent documentation.
Relative Value Units (RVUs)
Calculator →
Clinical Information
When to Use
Lumbar puncture (spinal tap) for diagnostic purposes - obtaining cerebrospinal fluid (CSF) sample
Common Scenarios
Documentation Requirements
- Clear indication for lumbar puncture (suspected diagnosis)
- Contraindications ruled out (elevated ICP, coagulopathy, infection at site)
- Patient positioning and needle insertion level (L3-L4, L4-L5, etc.)
- Opening pressure measured and recorded
- CSF appearance documented (clear, cloudy, bloody)
- Number of tubes collected and tests ordered
Coding Guidelines
Common Modifiers
Bundling Rules
- Includes local anesthesia and needle insertion
- CSF analysis tests (cell count, protein, glucose, culture) separately billable
- Fluoroscopic guidance (77003) separately billable if used
- Cannot bill with myelography if performed same session
Exclusions
- Do not use for therapeutic LP (CSF drainage) - use 62272
- Cannot bill if myelography performed (use 62284)
- Do not use for blood patch procedure (use 62273)
- Cannot bill if LP attempted but failed (no CSF obtained)
Coding Notes
Related CPT Codes
Clinical scenarios
- Clear indication for lumbar puncture (suspected diagnosis)
- Contraindications ruled out (elevated ICP, coagulopathy, infection at site)
- Patient positioning and needle insertion level (L3-L4, L4-L5, etc.)
- Clear indication for lumbar puncture (suspected diagnosis)
- Contraindications ruled out (elevated ICP, coagulopathy, infection at site)
- Patient positioning and needle insertion level (L3-L4, L4-L5, etc.)
- Clear indication for lumbar puncture (suspected diagnosis)
- Contraindications ruled out (elevated ICP, coagulopathy, infection at site)
- Patient positioning and needle insertion level (L3-L4, L4-L5, etc.)
Who are you?
Code Details
Medicare Pricing
PFSRVU Breakdown
OPPS Details
Automate Coding
Let OrbDoc AI automatically suggest codes from your clinical notes.
Patient? Check your bill.
Use our free analyzer to understand charges and spot errors.
Analyze My BillAsk OrbDoc AI
Get instant answers about 62270 - pricing, bundling rules, or billing questions.
Ask a QuestionFrequently Asked Questions
CPT 62270 is the billing code for "Spinal puncture, lumbar, diagnostic". Lumbar puncture (spinal tap) for diagnostic purposes - obtaining cerebrospinal fluid (CSF) sample
Medicare pays approximately $141.68 for CPT 62270 (national average). Actual payment varies by geographic location due to GPCI adjustments. Hospital and commercial insurance rates are typically 2-4x higher than Medicare rates.
CPT 62270 has a total RVU of 8.10, broken down as: Work RVU 1.50, Practice Expense RVU 6.20, and Malpractice RVU 0.40. RVUs (Relative Value Units) determine Medicare reimbursement rates.
The most common denial reason for CPT 62270 is "Insufficient indication - chronic headache without red flags warranting lumbar puncture". 62270 (lumbar puncture) denials occur when indication is vague or doesn't meet medical necessity. 'Chronic headache' alone is insufficient - must have red flags suggesting serious pathology (sudden onset, worst headache of life, neurologic deficits, fever, immunocompromised) or specific diagnostic need (suspected MS, meningitis, SAH after negative CT). Common causes include: Chronic migraines - LP not indicated for routine migraine diagnosis; Headache without fever, meningismus, neurologic signs. Appeal success rate is approximately 40-60%.
Key documentation requirements for CPT 62270 include: Clear indication for lumbar puncture (suspected diagnosis); Contraindications ruled out (elevated ICP, coagulopathy, infection at site); Patient positioning and needle insertion level (L3-L4, L4-L5, etc.); Opening pressure measured and recorded. Missing or incomplete documentation is a leading cause of claim denials for this code.
Bundling considerations for CPT 62270: Includes local anesthesia and needle insertion. CSF analysis tests (cell count, protein, glucose, culture) separately billable Use an NCCI bundling checker to verify specific code combinations before billing.
Common modifiers for CPT 62270 include: 50 (Not applicable (midline procedure)), 76 (Repeat procedure same day (if initial attempt failed)), 22 (Increased complexity (difficult anatomy, obesity, prior spine surgery)). Modifiers indicate special circumstances and can affect reimbursement or prevent claim denials.
The typical time requirement for CPT 62270 is 20-40 minutes including positioning and sample collection. Time-based codes require documentation of the actual time spent providing the service.