Neurosurgery Coding Alert

Question: What is the proper coding for a bilateral lumbar decompression (L4 and L5) with an L4/L5 microdiskectomy?

Oklahoma Subscriber  
Answer: For laminectomy (complete removal of the lamina) with removal of facets and foramina, report 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). The code descriptor specifies unilateral or bilateral, so no bilateral modifier is necessary or appropriate. Also, 63047 includes diskectomy and, therefore, the L4/L5 microdiskectomy should not be reported separately.
 
If a laminectomy is performed at two levels (e.g., L4 and L5), add 63048 ( each additional segment, cervical, thoracic, or lumbar [list separately in addition to code for primary procedure) to 63047. If the microdiskectomy adds significant time and effort, you might append modifier -22 (unusual procedural services) but you must have a strong basis for appeal (excellent documentation).
 
If the L4 and L5 laminae are only partially removed and diskectomy and/or facetectomy or foraminectomy are performed at the interspace, report 63030 (laminotomy [hemilaminectomy], with decompression of nerve root[s], including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disk; one interspace, lumbar [including open or endoscopically assisted approach) with modifier -50 (bilateral procedure) appended. Again, the microdiskectomy is included in 63030. In this case, because of the bilateral modifier, payment for the procedure should be 150 percent of the regular fee schedule amount.
 
Some non-Medicare payers will also allow payment for 69990 (microsurgical techniques, requiring use of operating microscope [list separately in addition to code for primary procedure]) if microdissection is performed.

  Clinical and coding expertise for You Be the Coder and Reader Questions provided by Eric Sandham, CPC, compliance educator for Central California Faculty Medical Group, a group practice and training facility associated with the University of California at San Francisco in Fresno.