Neurosurgery Coding Alert

Question: What is the correct modifier to use to denote additional levels during the same operative session when coding spine cases?

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Answer: No specific CPT modifier corresponds to additional levels, and, in most cases, you wont need modifiers to report a multilevel procedure.
 
For instance, you may report some types of multilevel procedures using add-on codes that specify each additional segment or each additional interspace. You should always report these codes in addition to a primary procedure code for the initial spinal segment or interspace, and, because of their status as add-on codes, they do not require modifiers. For example, 63300-63307 describe excision of intraspinal lesions by vertebral corpectomy (that is, partial or complete resection of the vertebral body). The surgeon selects the appropriate code according to location (cervical, thoracic or lumbar), incision depth (extra- or intradural) and approach (cervical, transthoracic, thoracolumbar, or transperitoneal or retroperitoneal).
 
Each of these codes specifies single segment and applies only to the initial spinal segment at which the surgeon performs corpectomy. You should report any additional segments beyond the first using add-on code +63308 ( each additional segment [list in addition to codes for single segment]), regardless of the location, depth of incision or approach.
 
When claiming more than one additional segment, you may report multiple units of 63308. For instance, if the patient required corpectomy at all levels from C2 to C5, you should report the procedure 63300 (for vertebral segment C2) and 63308 x 3 (for segments C3, C4 and C5).
 
CPT also uses multilevel or range codes to describe  surgeries of multiple spinal segments. For example, descriptors for laminectomy codes 63001-63005 specify one or two vertebral segments, while descriptors for 63015-63017, which describe equivalent procedures, specify more than two vertebral segments. Codes 63015-63017 are stand-alone codes that you should not report in addition to 63001-63005. You would never bill 63001 (Laminectomy with exploration and/or decompression of spinal cord and/or cauda equina, without facetectomy, foraminotomy or diskectomy [e.g., spinal stenosis], one or two vertebral segments; cervical) and 63015 ( more than two vertebral segments; cervical) during the same operative session, for instance, because each denotes a specific range of spinal segments (one or two, or more than two).
 
No modifiers are necessary, although an especially difficult or time-consuming procedure may warrant additional reimbursement. In this case, you may append modifier -22 (Unusual procedural services) to the appropriate procedure code.
 
Note: If the laminectomy ranges across spinal levels (for example, from cervical to thoracic or from thoracic to lumbar), choose the single code where the surgeon performed most of the work.
 
In one circumstance, CPT specifies a single code to report a procedure regardless of the number of spinal segments/interspaces involved. Codes 63250-63290 define excision by laminectomy of lesion other than herniated disk. Although the individual codes in this range describe various types of lesions (occlusion of arteriovenous malformation, intraspinal lesion other than neoplasm, etc.) and general locations (cervical, thoracic, etc.), none specifies, for instance, one or two vertebral segments or each additional interspace.
 
Surgeons and coders commonly (and incorrectly) report multiple units of 63250-63290 with modifier -51 (Multiple procedures) appended to the second and subsequent codes. But, when you report 63250-63290, the number of spinal segments/interspaces involved is incidental. These procedures are reported per region rather than per segment. If the lesion to be excised extends across general spinal levels (for instance, from thoracic to lumbar), the American Association of Neurological Surgeons Coding Scenarios recommends that you report the codes that best describe the lesions nature (for example, intradural) and locations.

  Clinical and coding expertise for You Be the Coder and Reader Questions provided by Eric Sandham, CHC, CPC, compliance manager for Central California Faculty Medical Group, a group practice and training facility associated with the University of California at San Francisco in Fresno.