Neurology & Pain Management Coding Alert

Question: I have several questions about billing with 63030. First, can we bill 63042 with 63030? Then, can we report procedures 63030 and +63035 with two surgeons? If so, do we need to include a separate op report? Maine Subscriber

Answer: To answer your first question, Correct Coding Initiative (CCI) edits list 63042 (Laminotomy [hemilaminectomy], with decompression of nerve root[s], including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disc, reexploration, single interspace; lumbar) as mutually exclusive to 63030 (Laminotomy [hemilaminectomy], with decompression of nerve root[s], including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disc, including open and endoscopically-assisted approaches; 1 interspace, lumbar). The edits, however, allow you to report both codes in some circumstances. If your physician performs the procedures at different levels, you can append modifier 59 (Distinct procedural service) to 63042 and report both procedures.

Two surgeons: If you're coding for two surgeons performing 63030 and +63035 (... each additional interspace, cervical or lumbar [List separately in addition to code for primary procedure]) together, you can report both physicians' services. Append modifier 62 (Two surgeons) to both procedure codes and include both surgeons' operative notes as documentation of their roles.