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 is considered an integral part of the surgical procedure and not separately billable. Also as you said, the CCI edits don't allow you to bypass the edit with a modifier and report both services. Because of this, it would not be compliant to report the transforaminal epidural at all -- you shouldn't submit add-on code +64484 (...lumbar or sacral, each additional level [List separately in addition to code for primary procedure]) if you don't first have the primary "parent" code 64483 either. You should report only 63047 and 63048 for the encounter.