Neurosurgery Coding Alert

Question: Is it ok for us to report code 63056 (Transpedicular approach with decompression of spinal cord, equina and/or nerve root[s] [e.g., herniated intervertebral disk], single segment; lumbar [including transfacet, or lateral extraforaminal approach) (eg, far lateral herniated intervertebral disc]) and code 22630 (Arthrodesis, posterior interbody technique, including laminectomy and/or discectomy to prepare interspace [other than for decompression], single interspace; lumbar) for the same interspace/segment?

Alaska Subscriber

Answer: You are wrong to report codes 63056 and 22630 for the same interspace/segment as this would represent duplicative work under most circumstances. You report code 22630 for the posterior (PLIF) or transforaminal (TLIF) approach lumbar interbody fusions. The code 22630 is inclusive of the surgical work done to access the disc space including a transfacet approach and this is an incidental component of the fusion procedure. Note that the descriptor of 22630 specifies that the code includes discectomy to prepare interspace (other than for decompression). Code 63056 describes a discectomy or corpectomy for decompression. Both codes involve discectomy but the discectomy described in code 22630 is the same or more extensive than that described in code 63056.

Code 63056 represents a transpedicular or transfacet approach where your surgeon adopts a posterolateral approach to the disc and/or vertebral body. Your surgeon makes a posterior incision and does posterolateral dissection to the anterior spinal region that enables simultaneous anterior and posterior spinal exposure for decompression and arthrodesis. Hence there is actually a removal of the posterior spinal structures (such as the lamina and facet joints) along with the anterior spinal structures (vertebral body and/or disc).