Neurosurgery Coding Alert

Question: A patient came to the ER with a CSF leak from a previous laminectomy. Our surgeon had to take the patient to the OR to repair the CSF leak (63709) and laminectomy (63047). Can you please help us to understand the bundling issues with codes 63047 and 63709? The cause of the CSF leak was not the surgical procedure done by our surgeon. Can we still bill for 63709 with a modifier? Please help.

Ohio Subscriber

Answer: The proper way to report this service is 63709 (Repair of dural/cerebrospinal fluid leak or pseudomeningocele, with laminectomy) to reflect that a laminectomy was required to repair the CSF leak.

Your scenario indicates that the surgeon performing this did not perform the original surgery. If the surgeon performing this is a partner of the original surgeon and the CSF leak repair is performed within the global period of the original laminectomy, you should append modifier 78 (Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period) to 63709.

The same would hold true if the surgeon performing the repair is the same surgeon performing the original laminectomy. If the surgeon performing the repair is neither a partner nor the original surgeon, no modifier would be required.

You are correct to identify the bundle of 63709 and 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). If the dural injury occurs during the operative laminectomy, CCI bundles the dural repair with the laminectomy procedure.

For example, if your surgeon performed a lumbar laminectomy 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. You do not report 63709 as CCI bundles 63709 into 63047.

You would therefore 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.