In the case of a cervical or dorsal blood patch, ct guidance is recommended, which ensures epidural application of the blood patch and minimizes the risk of damaging the spinal cord. We report the clinical and imaging presentation of a case of intracranial hypotension caused by. The procedure of blood patch involves injection of patients own blood in the epidural space. An epidural blood patch is a treatment for spinal headaches. English, epidural blood patch, blood patchs, epidural, epidural blood patchs, patch, epidural blood, patchs, epidural blood.
In this case the epidural blood patch is the treatment of choice. Epidural blood patch ebp the patients own blood is injected into the epidural space, the space just outside the dura within the spinal canal, forming a patch over the dura. Anesthesia epidural blood patch an epidural blood patch is used to relieve a certain type of headache. You may be able to bill for the blood patch 62273, injection, epidural, of blood or clot patch, but some carriers may not allow you to bill for the consult as well the carrier may say that the patient is an existing patient and is in the immediate postoperative period. In the procedure, a doctor will take a blood sample from a patient and then inject that blood back into a hole in the epidural space. How to code a lumbar puncture for a post epidural headache.
Cpt codes not covered for indications listed in the cpb. Jul 18, 2011 we present a case of successful treatment of chronic headache secondary to sih using a transforaminal epidural blood patch figures figures1 1 and and2. Blood patch what are the correct cpt codes and asa codes for billing a blood patch used of blood or clot patch. Under the medicare ncii edits, states 62273 can be billed with 62270 with a modifier. If you get a spinal headache after a procedure, the anesthesiologist can create a patch with your blood to seal the leak. A patient with a status post after or following lumbar puncture headache receives an epidural blood patch. I received a denial for a spinal puncture cpt 62270 billed along with the epidural blood patch cpt 62273. Transforaminal blood patch for the treatment of chronic.
The treatment options range from conservative supportive measures to epidural blood patch. After the injection of your blood, the bodys own healing system should take over and finish repairing the spinal fluid leak. Cpt 62273 injection, epidural, of blood or clot patch. Your healthcare provider will inject a sample of your own blood into your back, near the dural puncture site. Aug 17, 2018 an epidural blood patch is a surgical procedure that provides immediate relief to the headache caused by leaking spinal fluid. The patients venous blood is injected into the lumbar epidural space. An epidural blood patch may also help reduce other spinal fluid leak. Epidural blood patch technique, recovery, and success rate. The blood patch procedure consists of an injection at the spinal tap site of a small quantity of autologous blood. An alternative approach to traditional epidural blood patch administration in patients with postdural puncture headache who have an indwelling catheter has passed its first test. The procedure is coded as 62273 injection, epidural, of blood or clot patch. An epidural blood patch ebp is a procedure in which a small volume of autologous blood is injected into a patients epidural space to stop a. The blood clots, helping to patch punctures after a spinal tap procedure.
The autologous epidural blood patch ebp was first shown to be effective in the treatment of these lowpressure headaches in the 1970s. A very small percentage less than 1% in our practice of patients develop headache pain following a spinal anesthetic or epidural for labor analgesia. Although epidural steroid injections are frequently used to manage lumbar spinal pain, a number of complications may arise. Blood patchhow to code medical billing and coding forum aapc. Previously, ebps were performed using anatomical landmarks. This procedure is done to treat severe spinal headaches caused when an epidural, spinal needle or lumbar puncture accidentally punctures a hole in the outer membrane of the spinal cord causing a leak of spinal fluid. An epidural blood patch is a procedure used to relieve a headache caused by spinal fluid leak after a dural puncture. When the diagnosis is already known and the lp is performed for therapeutic drainage reasons, cpt 62272 2. And, because in most cases the anesthesiologist performs the blood patch instead of administering anesthesia for another physician to do it, you use the surgical procedure code instead of an anesthesia code. If you opt to try for consult reimbursement, consider using the appropriate evaluation and management em code, such as 99241 office consultation for a new or established. Contraindications to performing a blood patch include septicemia.
Our doctors are also experts at making the diagnosis of spinal fluid leak through the use of diagnostic mri, ct myelography and ct cisternography. Ctguided epidural blood patching of directly observed or. I have a group of crna that does sedation for a epidural blood patch, while the dr performs the procedure. Epidural blood patch is a treatment option for patients with craniospinal hypotension or post lumbar puncture headaches. The most appropriate diagnosis code to justify the anesthesia administered is 349. Lumbar transforaminal epidural blood patch pain medicine. Despite a high success rate at the 1st attempt with a blood patch of up to 85 %, some cases require repeating blood patching. Epidural blood patch inpatient care what you need to know. Cpt is a registered trademark of the american medical association. Cpt codes and descriptors only are 2017 american medical association. The clot that results forms a patch that contains the cerebrospinal fluid leak. Epidural blood patch precare what you need to know.
This headache is caused by the leakage of cerebral spinal fluid through a small hole in the lining that surrounds your spinal cord. By combined use of these techniques and ct guidance, the epidural blood patch can be placed exactly at the site of the spinal fluid leak. The 58yearold female presents with a severe headache due to a csf leak from a previous epidural injection for lower back pain 2 days ago. Success rates for blood patches are 90% for the first blood patch, and 95% for the second blood patch. Aetna considers epidural blood patching ebp medically necessary for the. This is most often done with fluoroscopic guidance and intravenous sedation by an anesthesiologist or a radiologist. Epidural blood patch what is an epidural blood patch why. Fluoroscopicallyguided epidural blood patch for spontaneous. Jul 20, 2017 in patients with postdural puncture headache. Blood patches are performed for treatment of a persistent headache spinal headache and nausea that sometimes follows a spinal puncture. Epidural blood patch an overview sciencedirect topics.
Guidelines autogenous epidural blood grafts are a safe and effective remedy to stop the pain of a severe headache that may. Jun 30, 2010 to perform an epidural blood patch, a procedure commonly performed in the ed, the anesthesiologist injects a small amount of the patients own blood into the site of the leak. Another spinal injection code, cpt 62273, is available for epidural blood patch. The blood patch is performed for a spinal headache from a cerebrospinal leak occurred after a spinal injection procedure. Blood patchhow to code medical billing and coding forum. The introduction of this blood acts to patch the hole in the dura the outer membrane of the spinal cord that was created by the needle at the time of myelography. Autogenous epidural blood graft is a procedure in which blood is removed from the patients vein and injected into the epidural space, to seal a spinal fluid leak. If these conservative and pharmacologic strategies do not achieve a satisfactory improvement in a reasonable time, an interventional approach should be considered. In consideration of the above points, the placement of an ebp near the leak might be more effective.
Im coding a fluoroscopicallyguided lumbar puncture and epidural blood patch. Sep 10, 2019 when the diagnosis is already known and the lp is performed for therapeutic drainage reasons, cpt 62272 2. Nov 09, 2016 cpt 62273 injection, epidural, of blood or clot patch. The procedure can be used to relieve post dural puncture headaches caused by lumbar puncture spinal tap. To put the blood patch in place, the anesthesiologist will. The headache is caused by a skin where the needle will go. A lumbar epidural autologous blood patch is usually placed in sih patients because the lumbar ebp is effective in 90% of cases.
If the first lumbar blood patch is ineffective, a second blood patch is applied in the thoracic region. Taking care of yourself after an epidural blood patch. Epidural patching medical clinical policy bulletins aetna. Understand coding for anesthesia services provided outside of. Spontaneous intracranial hypotension sih is rare, often misdiagnosed, as a cause of postural headaches. I understand the cpt codes for the epidural blood patch are.
Interventional radiology coding cardiology coding zhealth. Anesthesia for a blood patch medical billing and coding forum. Under epidural, it refers to see epidural, injection, then blood or clot patch, which refers to 62273. Blood patch therapy for spontaneous intracranial hypotension. Oct 09, 2015 an epidural blood patch is a surgical procedure that uses autologous it is also postulated that the relief of the headache after an epidural blood patch is due to. Approximately 1520 mls of blood is taken from a vein in the patients arm and subsequently injected into the epidural space in the spine at the site of the spinal fluid leak. The procedure can be done blind or under fluoroscopic or ct guidance, and is performed predominantly by radiologists and anes. This resulting blood clot patches the hole in the spine and treats the patients headache symptoms. An asa crosswalk code does not exist because most patients do not require anesthesia during the procedure. Sometimes after the above procedures, spinal fluid leaks out. Cpt code 62270, 62272, 62273 lumbar puncture anesthesia. An epidural blood patch is a surgical procedure that uses autologous blood in order to close one or many holes in the dura mater of the spinal cord, usually as a result of a previous lumbar puncture.
Tips for coding blood patch cpt code 62273 medical coding guide. Largevolume lumbar epidural blood patches, an approach adapted from the treatment of postlumbar puncture headache, are often used for treatment of spontaneous intracranial hypotension and can be effective immediately. Using a transforaminal approach allowed for placement of blood directly at the presumed site of csf leak when an interlaminar approach was not practical because of a previous laminectomy. We present a case of successful treatment of postdural puncture headache pdph using a lumbar transforaminal epidural blood patch tfebp. Epidural blood patch has traditionally been performed in the lumbar area, with few cases reported in the thoracic and lower cervical spine 1, 3, 4. Sih is caused by an atraumatic cerebrospinal fluid csf leak usually secondary to structural dural weakness. This complication can happen after a spinal tap, an epidural for labor and delivery, or another procedure that requires a spinal puncture. Epidural catheter offers alternative to traditional blood. Feb 03, 2020 an epidural blood patch is a procedure used to relieve a headache caused by spinal fluid leak after a dural puncture. An epidural blood patch is a surgical procedure that uses autologous it is also postulated that the relief of the headache after an epidural blood patch is due to.1211 1330 1424 1239 958 148 149 493 781 247 133 626 462 1279 453 96 740 223 640 1272 238 711 1404 147 1187 265 876 553 379 508 242 1118 735 628 204 610 424 906 1145 1451 585 768 942 1457 XML HTML