Neurology & Pain Management Coding Alert

Question: Our physician performed two levels of lumbar laminectomy on a Medicare patient. We initially thought of reporting codes 63047, +63048, 64483, and +64484. But CCI edits bundle 64483 into 63047 and don't allow you to break the edit with a modifier. Would the correct coding be 63047, +63048, and 64483?New Jersey Subscriber Answer: It's a bit unusual for a physician to administer transforaminal epidural injections during the same session as laminectomy, but different situations help keep coding interesting. As you've noted, CCI edits bundle 63047 (Laminectomy, facetectomy and foraminotomy [unilateral or bilateral with decompression of spinal cord, cauda equina and/or nerve root(s), (e.g., spinal or lateral recess stenosis)], single vertebral segment; lumbar) and 64483 (Injection[s], anesthetic agent and/or steroid, transforaminal epidural, with imaging guidance [fluoroscopy or CT]; lumbar or sacral, single level). That's because the injection of a local anesthetic or steroid at the site of the lumbar decompression [...]