Neurosurgery Coding Alert

Question: How can we report the repair of a traumatic dural laceration? Is there a separate code for the dural graft? Can we append modifier 22 (Increased procedural service) for the laminectomy access?

Georgia Subscriber

Answer: You have the following choice for dural repair procedures:

• 63707, Repair of dural/cerebrospinal fluid leak, not requiring laminectomy
• 63709, Repair of dural/cerebrospinal fluid leak or pseudomeningocele, with laminectomy
• 63710, Dural graft, spinal.

You can select from these codes based upon the work associated with dural repair. You report the appropriate code based upon the need for a laminectomy to complete the repair, with 63707 indicating a repair without a laminectomy and 63709 indicating a repair with a laminectomy. You do not append modifier 22 for laminectomy, which is included in the work of CPT^® 63709-63710. You submit code 63710 when your surgeon uses a dural graft to complete the repair.

Note: You should be specific about when to report the dural repair procedures:

• These codes are not for iatrogenic dural repairs, i.e. small incidental laceration in the dura during the course of another surgical procedure.
• During intradural procedures, e.g. resection of spinal cord tumors, the repair of dura is bundled in the primary procedure and you cannot repair it separately.

Specify microdissection, when used: When your surgeon uses a microscope for the dural repair procedure, you can submit code +69990. The codes for dural repair are not inclusive of microdissection.