Journal de la colonne vertébrale

Economic Outcomes of the Addition of Fluoroscopic Guidance to the Lumbar Puncture Procedure: A Call for Standardized Training

Abstract

Richard P Menger, Peyton WA, Matthew Hefner, Anil Nanda and Hugo Cuellar

Objectives:

1. To evaluate the socio-economic impact of the addition of fluoroscopic guidance to the lumbar puncture procedure through our institutional series from 2010 to 2013.

2. To investigate the increased cost and socio-economic impact associated with fluoroscopic guidance, which at our institution is used after failure of blind procedure.

3. To describe the utility of standardized training to decrease the number of failed bedside lumbar Patients and methods: A retrospective analysis of 211 lumbar punctures from LSU Health Sciences in Shreveport, LA was analyzed under the current neuroendovascular faculty (2010-2013) via use of billing data. Results were restricted to lumbar punctures performed for diagnostic (CPT 62270) or therapeutic codes (62272) with the addition of fluoroscopic guided placement of needle (77003). Neurosurgical resident lumbar punctures are not billed for by the department and therefore are not accounted for in analysis.

Results: 88 lumbar punctures performed were diagnostic and 123 were billed as therapeutic. 93 cases were done with addition of fluoroscopic guidance either directly from neurosurgical resident blind procedure failure or consulting service blind procedure failure. 70 patients were free care with no charge. The department billed $80,469 and collected $13,004 for the actual lumbar puncture procedure (62270 and 62272). The average additional billing cost for fluoroscopic guidance was $356. However, of the additional $41,649 billed only $2014 was collected. For the additional use of fluoroscopy, the mode for Medicaid re-imbursement was $19 and for Medicare was $41. This does not take into account the additional use of radiology technologists, procedural nursing, and recovery nursing.

Conclusion: This study is limited by information available for retrospective review. Fluoroscopic guided lumbar punctures utilize skills and procedural time of the neuro-interventionalist. Focused standardized training of residents, which has been proven to improve lumbar puncture success outcomes, would reduce the use of these valuable resources.