Neurosurgery Coding Alert

Question: Our neurosurgeon suggested that we bill 63056 for the coblation of L4-L5 and coblation of L5-S1. Now someone else says 62287 is the better code. The operative note says no specimens were removed. What's the correct choice?

Kansas Subscriber

Answer: Your advisor is correct -- you typically report 62287 (Decompression procedure, percutaneous, of nucleus pulposus of intervertebral disc, any method, single or multiple levels, lumbar [e.g., manual or automated percutaneous discectomy, percutaneous laser discectomy]) for coblation, assuming the surgeon used a percutaneous approach. Code 62287 is better than 63056 as your physician suggested for multiple reasons:

• Coblation is typically a percutaneous procedure.

• Code 63056 (Transpedicular approach with decompression of spinal cord, equina and/or nerve root[s] [e.g., herniated intervertebral disc], single segment; lumbar [including transfacet, or lateral extraforaminal approach] [e.g., far lateral herniated intervertebral disc]) represents an open procedure.

Heads up: Some carriers consider this an experimental procedure and do not allow reimbursement. In addition, CMS announced in Transmittal 97 (dated Dec. 9, 2008) that TIPs (thermal intradiscal procedures) are not reasonable and necessary for low back pain treatment, so CMS doesn't cover procedures that use a radiofrequency energy source or electrothermal energy to apply or create heat and/or disruption within the disc to treat low back pain. (To read the CMS transmittal, go to www.cms.hhs.gov/transmittals/downloads/R97NCD.pdf.)

Result: Check with the carrier to determine if it accepts 62287. If you know the carrier will deny the claim, obtain a signed advance beneficiary notice (ABN) from the patient acknowledging that he will be responsible for payment if the carrier isn't.