Neurosurgery Coding Alert

Question: How should I report a right L4-L5 "redo" laminectomy, foraminotomy and discectomy? What about 63047 with modifier 22 appended? New Hampshire Subscriber Answer: Forego 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; lumbar) in favor of 63042 (Laminotomy [hemilaminectomy], with decompression of nerve root[s], including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disc, re-exploration, single interspace; lumbar), even if the redo laminotomy/hemilaminectomy extends to create a laminectomy (removal of entire laminar segment). The code descriptor for 63042 specifically states "re-exploration," and therefore includes typical additional work required for operating in an altered surgical field, which may include dissection of scar tissue and adhesions. Therefore, you should leave modifier 22 (Increased procedural services) off the claim.