Neurosurgery Coding Alert

Question: In a patient with recurrent disc herniation at L5-S1 with S1 radiculopathy, our surgeon did a repeat right L5-S1 microdiscectomy. Our surgeon also did a left L5-S1 microdiscectomy. How can we code for these procedures?

Alaska Subscriber

Answer: This is an unusual circumstance for which there is not a clear singular answer. This procedure could be reported as 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), which includes bilateral laminectomy and discectomy. One could also report this with 63030 (Laminotomy [hemilaminectomy], with decompression of nerve root[s], including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disc; 1 interspace, lumbar) and modifier 50 (Bilateral procedure), but this likewise understates the additional work involved in the unilateral re-exploration discectomy. In contrast, 63042 (Laminotomy [hemilaminectomy], with decompression of nerve root[s], including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disc, reexploration, single interspace; lumbar) with modifier 50 overstates the work involved in the unilateral discectomy performed on the previously untreated side, though some argue that scaring tissue from the previous surgery may extend to the untreated side. While it would seem that the most accurate reporting would be 63042 and 63030-59, this may not be recognized by the payer when performed at the same interspace level, even though performed on opposite sides.