Neurosurgery Coding Alert

Question: The patient underwent laminectomy, 63047 (Laminectomy, facetectomy and foraminotomy (unilateral or bilateral with decompression of spinal cord, cauda equina and/or nerve root[s], [eg, spinal or lateral recess stenosis]), single vertebral segment; lumbar) and +63048 (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; each additional segment, cervical, thoracic, or lumbar [List separately in addition to code for primary procedure]), in the month of April. In June (within 90 days), the same surgery was needed to be done again. We billed 63047-78 (Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period), 63048-78 since it was within the 90 days.  It was denied by the carrier for procedure/modifier being incorrect.  We later tried with modifier 76 (Repeat procedure or service by same physician or other qualified health care professional) and there was another denial. Can you please help us to understand the reason for the denial and how we can report this?

Maryland Subscriber

Answer: You need to check the operative note to confirm why the patient was taken to the OR again. Modifier 76 is correct for a repeat procedure within the global period. If the procedure was done at a different level when the patient was returned to the OR, you would report 63047 appended by modifier 79 (Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period), assuming a different diagnosis that prompted the additional surgery.