Summary & Overview
CPT 62269: Spinal Cord Needle Biopsy for Tissue Diagnosis
CPT code 62269 represents a needle biopsy of the spinal cord performed to obtain tissue for diagnostic evaluation. This invasive diagnostic procedure is clinically significant for definitive diagnosis of intramedullary spinal lesions when imaging and less invasive sampling are inconclusive. Nationally, accurate coding and documentation for spinal cord biopsy affect care pathways, perioperative planning, and appropriate utilization of high-acuity resources.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context, typical sites of service, and payer coverage considerations. The publication also outlines common billing modifiers and provides guidance on what information is typically necessary for claims adjudication. Policy updates and benchmarking content are summarized to help stakeholders understand reimbursement patterns and documentation expectations across major payers.
The article is designed for coding professionals, hospital billing teams, neurosurgeons, and compliance officers seeking a national view of how CPT code 62269 is used, what clinical scenarios prompt its use, and what documentation elements support appropriate billing. Data not available in the input will be noted where relevant.
Billing Code Overview
CPT code 62269 describes a procedure in which a provider inserts a needle into the spinal cord to collect a tissue sample for diagnostic testing. This service is a type of spinal cord biopsy intended to obtain histologic or cytologic specimens when less invasive methods are insufficient.
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Service type: Spinal cord biopsy via needle insertion
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Typical site of service: Hospital inpatient or hospital outpatient setting, or specialized surgical center capable of spinal procedures
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Clinical & Coding Specifications
Clinical Context
A typical patient is a 45–70-year-old adult presenting with progressive neurological signs such as unexplained limb weakness, sensory changes, or gait disturbance and an intramedullary spinal cord lesion identified on MRI. The neurosurgeon or interventional neuroradiologist evaluates imaging and clinical risks and schedules a percutaneous spinal cord biopsy to obtain tissue for histopathology, microbiology, or molecular testing when noninvasive testing cannot establish a diagnosis. The procedure is performed in an operating room or interventional suite with the patient under general anesthesia or monitored anesthesia care. Fluoroscopic or CT guidance is used to localize the target level; a sterile field is prepared and a needle or small biopsy instrument is advanced into the spinal cord at the planned entry. Multiple small cores or a single core sample are obtained, hemostasis is confirmed, and the needle is withdrawn. The patient is observed postoperatively in a recovery area or inpatient setting for neurological monitoring and pain control, with postoperative imaging as indicated. Documentation includes informed consent, indication, imaging guidance used, level and laterality, specimen handling, anesthetic type, complications if any, and the provider performing the service.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
11 | Office or other outpatient service code | Use when the provider is the primary surgeon and reports a standard service without unusual circumstances. |