Neurosurgery Coding Alert

Question: A patient who had a previous laminectomy reported to the ER with a CSF and our surgeon had to take the patient to the OR to repair the CSF leak (63709) and laminectomy (63047). Can we bill for 63709 with a modifier as 63709 and 63047 are bundled?

New Mexico Subscriber

Answer: You have correctly picked up the bundle between 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 63709 (Repair of dural/cerebrospinal fluid leak or pseudomeningocele, with laminectomy). CCI bundles the dural repair with the laminectomy procedure if the dural injury occurs during the operative laminectomy. However, if your surgeon does a subsequent laminectomy to facilitate repair of the dura, you would only bill the CPT® 63709 for the CSF leak repair spine procedure. In the situation cited by you, 63709 is the only code you would report. You do not append any modifiers to 63709 unless you are in the global period of the original laminectomy, and then you would append modifier 78.