Neurosurgery Coding Alert

Concurrent laminectomies are your guide.

When repairing a dural tear, your surgeon may or may not need to perform a laminectomy to access the tear for a repair. Appropriately coding these dural tear procedures will depend on whether the operative note indicates that the surgeon performed a laminectomy and what graft was used for the repair. You'll choose from these 3 codes when your surgeon does a repair of the dura in the spine to contain a cerebrospinal fluid (CSF) leak.

• 63707 (Repair of dural/cerebrospinal fluid leak, not requiring laminectomy)
• 63709 (Repair of dural/cerebrospinal fluid leak or pseudomeningocele, with laminectomy)
• Code 63710 (Dural graft, spinal)

Read on for three operative situations that illustrate the correct use of these codes

Scenario 1: Dural Repair without Laminectomy

If you read in the operative note that the surgeon did a laminectomy during which the dura was punctured and the surgeon then repaired the dual leak at the same level, you will not be able to bill the dural repair with the laminectomy as the CSF leak occurred as a complication from an incidental puncture. In this case, you would only report the laminectomy. However, if your surgeon makes significant efforts to repair the dural break, you may report 63707 (Repair of dural/cerebrospinal fluid leak, not requiring laminectomy) along with the laminectomy code. You would also append modifier -51 (Multiple procedures:...) to 63707.

Scenario 2: Dural Repair with Laminectomy

Your surgeon may perform a laminectomy for dural repair. The neurosurgeon may need to access the dural injury by doing a laminectomy either above or below the site of a previous surgery.

Bundling issues: If the dural injury occurs during the operative laminectomy, CCI bundles the dural repair with the laminectomy procedure. For example, if you read in the operative note that the surgeon performed a lumbar laminectomy, facetectomy and foraminotomy, and during this procedure there was a dural tear that created a fluid leak and the surgeon subsequently repaired the dural injury with Nurolon, you only report 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). You do not report 63709 as CCI bundles 63709 into 63047.

"You would not report 63709 and 63047 together. If your surgeon does the procedure for a decompression and laminectomy and also repairs the dura, you would only bill the CPT® 63047 for the spine procedure," says Teresa Thomas, BBA, RHIT, CPC, practice manager II at St. John's Clinic (Neurosurgery) in Springfield, Missouri.

Scenario 3: Applying Grafts

Your surgeon may use a synthetic dural graft or bovine pericardium to seal the dural leak. In this situation, you would report 63710 for the dural graft placement.

Tip: Codes 63707 and 63709 are inclusive of approach, repair and closure in the procedure of the dural repair. "These codes include the approach, procedure and closure of the wounds," says Rena Hall, CPC, Billing/Coding, Kansas City Neurosurgery Group, Kansas City, MO.

Code 63710 does not include the spinal approach and closure, hence you report this code only when the surgeon uses a graft to repair the dura during another, related procedure such as laminectomy for decompression. "You would bill 63709 when a pseudomeningocele is caused by postoperative complications or trauma. Code 63710 would be used if a graft was needed to aid in the repair," says Thomas.

And Don't Forget the ICD Code

Never miss reporting the diagnosis codes to support your claim. You report the dural tear with code 349.31 (Accidental puncture or laceration of dura during a procedure). The corresponding ICD-10 code is G97.41 (Accidental puncture or laceration of dura during a procedure).