Neurosurgery Coding Alert

Navigating the anatomy and terminology of spinal procedures is a tricky path to tread on many fronts. If counting and calculating interspaces and segments has you mystified, read on for advice that will help your spinal claims stand tall.

Learning the difference between vertebral segments and interspaces stymies many coders. Follow this guide from the North American Spine Society "Common Coding Scenarios for Comprehensive Spine Care":

• Vertebral segment describes the basic constituent part into which the spine may be divided. It represents a single complete vertebral bone with its associated articular processes and laminae.

• Vertebral interspace describes the non-bony compartment between two adjacent bodies which contains the intervertebral disc and includes the nucleus pulposus, annulus fibrosus, and two cartilagenous end plates.

Another clue: Anatomically, a single spinal nerve exists in the vertebral space between two vertebrae. For example, the L5 spinal nerve passes across the L4 and L5 vertebrae at the L4-L5 interspace.

"Coders need to clarify with their providers as to their use of anatomic nomenclature when they're describing the spinal nerve or the vertebral interspace," advises Marvel Hammer, RN, CPC, CCS-P, PCS, ACS-PM, CHCO, owner of MJH Consulting in Denver, Co. For example:

• A dash used between two vertebra (L4-L5) typically indicates a single interspace.

• A comma between two vertebra (L4, L5) could be interpreted a couple of different ways. The comma might designate two vertebrae that the surgeon treated, or might indicate two spinal nerves that exit between two vertebral interspaces. Because of the different possibilities, ask specifics about your surgeon's documentation. Knowing his documentation preferences will help you interpret his notes more accurately and guide your coding.

With those tips in mind, consider this scenario from coder Michelle Benz and decide your best coding approach.

The case: Your neurosurgeon performs L4-L5 microdiscectomy. Would you report only 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)? Would you assign 63047 with +63048 (... each additional segment, cervical, thoracic or lumbar [List separately in addition to code for primary procedure])? Or is another code your most accurate choice?

Solution: "From what I've seen, providers don't typically remove the full lamina when performing microdiscectomy," Hammer says. If that's the case in the surgery you're coding, you'll actually report 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 dash in your surgeon's notes indicates a single interspace between L4 and L5, so you won't include +63035 (... each additional interspace, cervical or lumbar [List separately in addition to code for primary procedure]). The same would hold true if you were coding a full laminectomy represented by 63047.