Neurosurgery Coding Alert

Question: Our local carrier is not reimbursing 22630 when reported with 63047. How should we code if these procedures are performed at different levels, for example L4-L5 and L5-S1?

California Subscriber

Answer: Code 22630 (Arthrodesis, posterior interbody technique single interspace; lumbar) includes laminectomy, facetectomy and diskectomy to prepare the interspace for posterior lumbar interbody fusion, and the national Correct Coding Initiative (CCI) bundles 63047 (Laminectomy, facetectomy and foraminotomy lumbar) with it. The edit includes a "1" indicator, however, which means a modifier may be used "to differentiate between the services provided" at different times or at different locations on the body.

For instance, if the laminectomy is done at a different level, you may report 63047 with modifier -59 (Distinct procedural service) appended. It is open to interpretation whether decompression beyond what would be required for site preparation at the same level as a posterior interbody fusion is a sufficiently different "location" to warrant modifier -59. Because it is the intent of CPT-4 that decompressive laminectomies be listed in addition to the fusion, however, you should be confident in using modifier -59 in this case and successfully rebut any claims of "unbundling."