Neurosurgery Coding Alert

Question: Which are the appropriate codes for removal of pseudoarthrosis and redo laminotomy (L2/L3)? "Pseudoarthrosis" isn't listed in the CPT index.

New Jersey Subscriber

 Answer: If the re-exploratory laminotomy included nerve decompression, facetectomy or foraminotomy, use 63042 (Laminotomy [hemilaminectomy], with decompression of nerve root[s], including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disk, re-exploration, single interspace; lumbar). This procedure includes the removal of the old pseudoarthrosis in the re-exploration. If the removal is complex and significantly extends the time and effort to perform the procedure, the surgeon may seek additional reimbursement by appending modifier -22 (Unusual procedural services) to the re-exploration code and submitting the claim with an operative report.

For a minimal laminotomy only, report the pseudo-arthrosis removal with 22830 (Exploration of spinal fusion).