Neurosurgery Coding Alert

Question: On Jan 3, 2013, our surgeon did a laminectomy for stenosis on L2,3,4 and 5 which we reported with codes 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 63048 (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; each additional segment, cervical, thoracic, or lumbar [List separately in addition to code for primary procedure]) x2.

On Jan. 9, 2013, the patient had a fall and was taken back for extension of L1 laminectomy and extension of foraminotomies at L2, 3 and 4 because of new foraminal stenosis and hematoma. How do we report this? Can we bill 10140 (Incision and drainage of hematoma, seroma or fluid collection) for the hematoma? Please help for the right codes for this situation.

New Mexico Subscriber

Answer: You are correct to report 63047/63048 for laminectomy at the lumbar levels. If three different segmental nerves were decompressed at the three joint levels (L23, L34 and L45), you correctly reported one unit of 63047 and 2 units of 63048. If however, four segmental nerves were decompressed, you would report three units of 63048 in addition to 63047.

In order to assign proper coding for the second operation, more information would need to be provided. It would seem more likely that the hematoma occurring six days after surgery is most likely a postoperative complication of the original surgery. Degenerative foraminal stenosis would not develop in that time interval. If this is the case, the second procedure would be reported with 10140-78.