Inpatient Facility Coding & Compliance Alert

Question: Surgery was performed due to recurrent HNP (herniated nucleus pulposus) at L5-S1 and a new HNP at L4-L5. How should we code this?

Hawaii Subscriber

Answer: You’ll report treatment of the recurrent HNP at L5-S1 with 63042 (Laminotomy [hemilaminectomy], with decompression of nerve root[s], including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disc, reexploration, single interspace; lumbar). Because the HNP at L5-S1 is recurrent, your surgeon is dealing with a more complicated procedure.

You might be able to append modifier 22 (Increased procedural services) to 63042, depending on the documentation.

Then report 63030 (Laminotomy [hemilaminectomy], with decompression of nerve root[s], including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disc; 1 interspace, lumbar) for the new HNP. 

Note that for some payers, this code pair may invoke an edit, and the use of the 59 modifier (Distinct procedural service) may need consideration.