Neurosurgery Coding Alert

Question: When reporting multiple units of a single procedure, should I use the "units" box for the number of units or list each unit separately on an individual line?

Georgia Subscriber

Answer: As a general rule, you should use the "units" box of the CMS claim to report multiples of a single identifiable code. For instance, the surgeon performs lumbar laminectomy with decompression at three levels. You report this using a single unit of 63047 (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; cervical) and two units of +63048 (... each additional segment, cervical, thoracic or lumbar [list separately in addition to code for primary procedure]), as two line items:
 
63047
63048 x 2.

But in some cases when you report multiple units of a single code, you must append modifier -59 (Distinct procedural service) to identify that each procedure occurred at a separate anatomic location. Simply listing the procedure code and the number of units may result in denial of the subsequent units as repeat procedures.

For example, the surgeon administers three steroid injections (62310, Injection, single [not via indwelling catheter], not including neurolytic substances, with or without contrast [for either localization or epiduro-graphy], of diagnostic or therapeutic substance[s] [including anesthetic, antispasmodic, opioid, steroid, other solution], epidural or subarachnoid; cervical or thoracic) at three separate cervical levels. If you report this as 62310 x 3, the payer may reject the second and third units as redundant. However, if you report 62310, 62310-59 x 2 (as two separate line items), you indicate to the payer that the second and third units occurred at separate anatomic locations from the first injection.