Neurosurgery Coding Alert

Question: What is proper coding for repair of postlaminectomy syndrome?

Arkansas Subscriber Answer: You should use the reoperative laminotomy (63040-63044) to report surgical treatment of post-laminectomy syndrome. Following one or more low-back surgeries (for example, 63030, Laminotomy [hemi-laminectomy], 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]), patients may have pain arising from spinal instability, scar tissue or adhesion development, bone spur growth, and/or regeneration of previously excised bone. Surgeons may treat "postlaminectomy syndrome" (722.8x) surgically if less invasive treatments (such as analgesics, muscle relaxants and physical therapy) do not provide relief.
 
Codes 63040 (Laminotomy [hemilaminectomy], with decompression of nerve root[s], including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disk, reexploration, single interspace; cervical) and 63042 (... lumbar) describe the surgeon's exploration of a single interspace.
 
Two codes, introduced in 2001, describe additional interspace exploration beyond the first: +63043 (... each additional cervical interspace [list separately in addition to code for primary procedure]) and +63044 (... each additional lumbar interspace ...). CMS assigned these codes a "C" status indicator in the Physician Fee Schedule, meaning they are "carrier-priced codes." Individual carriers will establish relative value and payment amounts for these services, "generally on a case-by-case basis following review of documentation, such as an operative report," according to CMS. Although surgeons can expect widely varying reimbursement depending on the carrier, you should report 63043-63044 and expect payment, when the codes apply.
  
CPT specifically describes 63040-63044 as unilateral procedures. Therefore, if the surgeon performs the exploration bilaterally (that is, on both the left and right), you should append modifier -50 (Bilateral procedure) to the applicable codes. Insurers generally increase payment for codes appended with modifier -50 to 150 percent of the standard amount.
 
For example, the neurosurgeon treats a 50-year-old male with postlaminectomy syndrome. The surgeon excises bone spurs on both the left and right at L4/L5, then moves upward to remove adhesions from both sides of the L3/L4 and the left L2/L3 interspaces. In this case, you should report the procedure with 63042-50, 63044-50 and 63044 to describe the surgeon's bilateral exploration at the first interspace, as well as the surgeon's bilateral and unilateral exploration of two additional lumbar interspaces.