Neurosurgery Coding Alert

Question: Should we append modifier 50 for a bilateral lumbar laminectomy?

Washington Subscriber

Answer: As specified in the code descriptors, all laminectomy procedures include unilateral or bilateral procedures, including 63001-63017, 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)] ...) and +63048 (... each additional segment, cervical, thoracic or lumbar [list separately in addition to code for primary procedure]).

In addition, the CMS fee schedule assigns these procedures a bilateral status indicator of "2," which means "payment adjustment does not apply because relative value units assume the procedure is bilateral." Therefore, you may not append modifier 50 (Bilateral procedure) to report a procedure on both the left and right side of the spine.