Neurosurgery Coding Alert

Question: If a patient has a repeat lumbar micro-diskectomy for a recurrent herniated disk within the 90-day global period of an identical procedure, should we report 63030 or 63042? Is a modifier necessary?

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Answer: Assuming that you reported 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]), the correct coding for a repeat procedure during the 90-day global period is 63030 appended with modifier -78 (Return to the operating room for a related procedure during the postoperative period).
 
Although 63042 (Laminectomy [hemilaminectomy], with decompression of nerve root[s], including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disk, re-exploration, single interspace; lumbar) describes a re-exploration, it is "intended for disk surgery at a location previously operated upon more than 90 days in the past," according to the recommendations of the American Association of Neurological Surgeons (AANS). Therefore, you should use 63042 (and related code 63040, ...cervical) to describe re-explorations taking place after the global period of the original laminectomy has expired. Codes 63040 and 63042 have higher payments for the difficulty of dissecting through a scarred field - which usually doesn't become significant until some time has passed.