Neurosurgery Coding Alert

Question: Recently, our surgeon performed a laminectomy for removal of intraspinal lesion at segments L2, L3 and L4. I reported the procedure 63272, 63272-51 (Multiple procedures) X 2, but the claim was rejected. Why won't the payer reimburse the claim?

Texas Subscriber

Answer: The payer rejected your claim because 63272 (Laminectomy for excision of intraspinal lesion other than neoplasm, intradural; lumbar) is a "regional" code that cannot be reported more than once per session. In other words, only one unit of 63272 (along with all codes in the 63250-63290 range) may be reported, regardless of the number of spinal levels. Codes 63250-63290 are reported per lesion, rather than per segment. This can cause confusion for coders who are familiar with using add-on or multi-level codes to report surgeries involving several vertebral segments or interspaces.

Therefore, when you code such a procedure, the size of the lesion makes no difference codes 63250-63290 are "all-inclusive." You would report excision of a lesion at a single lumbar vertebra the same as excision of the same type of lesion spanning four lumbar vertebrae: 63272. Reporting 63272, 63272-51 x 2 for the procedure you describe is therefore "double-billing."

You may append modifier -22 (Unusual procedural services) to 63250-63290 to increase reimbursement for an unusually difficult or time-consuming surgery, but modifier -22 is not warranted just because a lesion reaches across several vertebrae. It could be justified, however, if a previous surgery had left extensive scarring or adhesions, thereby complicating excision of the targeted lesion and increasing the time and/or effort usually required for a lesion of that type and size, for instance.

Also, if the lesion to be excised extends across general spinal levels (e.g., from thoracic to lumbar), only the code that best describes the lesion's location should be reported. For example, if the surgeon removes an arteriovenous malformation that spans from T10 to L1, the majority of the lesion is in the thoracic region, and you should report 63251 (Laminectomy for excision or occlusion of arteriovenous malformation of spinal cord; thoracic).

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.