Neurosurgery Coding Alert

Turn to modifier -50 for bilateral procedures

When your neurosurgeon performs surgical treatment for postlaminectomy syndrome, you should reach for reoperative laminotomy codes 63040-63044.
 
Background: Following one or more low-back surgeries (for instance, 63030, Laminotomy [hemilaminectomy], with decompression of nerve root[s], including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disk; one interspace, lumbar [including open or endoscopically assisted approach]), patients may have pain from spinal instability, scar tissue or adhesion, bone spurs, and/or regeneration of previously excised bone.

The surgeon may correct this "postlaminectomy syndrome" (722.8x) if less invasive treatments (such as analgesics, muscle relaxants, steroid injections or physical therapy) do not provide relief.

Call on 63040-63042 for Initial Level

For the first interspace the surgeon explores, you should choose either 63040 (Laminotomy [hemilaminectomy], with decompression of nerve root[s], including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disk, re-exploration, single interspace; cervical) or 63042 (... lumbar), depending on whether the surgeon access the cervical or lumbar spine, says Tara Conklin, CPC, healthcare consultant with CRN-Institute in North Port, Fla.
 
There's more: For each additional interspace beyond the first that the surgeon treats, you should report +63043 (... each additional cervical interspace [list separately in addition to code for primary procedure]) or +63044 (... each additional lumbar interspace [list separately in addition to code for primary procedure]).

Tip: You should link 63043 with 63040 only, and link  63044 with 63042 only.

Break Out -50 for Bilateral Procedures

Because CPT specifically describes 63040-63044 as unilateral procedures, you should append modifier -50 (Bilateral procedure) if the surgeon performs the exploration bilaterally (that is, on both the left and right side of the same interspace), Conklin says.

Example: A 58-year-old male with postlaminectomy syndrome undergoes surgery to remove bone spurs and adhesions from multiple lumbar levels.

The surgeon excises bone spurs on both the left and right side at interspace L4/L5, then moves upward to remove adhesions from both sides of the L3/L4 interspace and the left L2/L3 interspace.

In this case, you should report 63042-50, 63044-50 and 63044 to describe the surgeon's bilateral exploration at the first interspace, as well as the bilateral and unilateral exploration of two additional lumbar interspaces.

You should link a diagnosis of 722.83 (Post-laminectomy syndrome; lumbar region) to your CPT codes.

Demand Payment for 63043, 63044

Practices reporting reoperative laminotomy codes will notice inconsistent reimbursement for 63043 and 63044, but you should expect some payment for these procedures.

CPT assigns a "C" status indicator to 63043/63044, meaning that these codes are "carrier-priced."

In other words, individual carriers will establish RVU and payment amounts for these services, "generally on a case-by-case basis following review of documentation, such as an operative report," according to CMS. CMS specifically states, however, that separate reimbursement will be allowed for carrier-priced codes.

Last word: Because 63043/63044 are designated add-on codes, you should not append modifier -51 (Multiple procedures), nor should payers apply "multiple-procedure reductions," to these codes.