Neurosurgery Coding Alert

Question: My surgeon did a reduction of kyphotic dislocation at L2; laminectomies at L1, L2 and L3 bilaterally; and fusions at L1, L2 and L3 with local autograft stabilization with segmental instrumentation L1 through L3. How should I report this?


New Mexico Subscriber

Answer: Report the L2 reduction with 22325 (Open treatment and/or reduction of vertebral fracture[s] and/or dislocation[s], posterior approach, one fractured vertebra or dislocated segment; lumbar).

Because there's no indication of a foraminotomy or facetectomy, you should report the laminectomies that your doctor performed at L1, L2, L3 using 63017 (Laminectomy with exploration and/or decompression of spinal cord and/or cauda equina, without facetectomy, foraminotomy or diskectomy [e.g., spinal stenosis], more than 2 vertebral segments; lumbar). Append modifier 51 (Multiple procedures) to 63017 to show that the neurosurgeon did the procedure in addition to the reduction (22325). There's no need to add 59 to 63017 since the codes are not bundled.

Note the CPT commentary at the bottom of this section, which directs you to -see 63001-63091 for decompression of spine following fracture.-

Your coding becomes more difficult if a physician performs a foraminotomy or facetectomy during the laminectomy. Code 63047 (Laminectomy, facetectomy and foraminotomy [unilateral or bilateral with decompression of spinal cord, cauda equina and/or nerve roots(s) (e.g., spinal or lateral recess stenosis)], single vertebral segment; lumbar) is bundled with 22325. In this case, you should attach modifier 59 (Distinct procedural service) to 22325 but only bill for laminectomies at L1 and L3.

If you report the third laminectomy using +63048 (- each additional segment, cervical, thoracic, or lumbar [list separately in addition to code for primary procedure]) to payers that don't follow the National Correct Coding Initiative bundling policies, be prepared to appeal any denials.

For the fusions, you would report 22612 (Arthrodesis, posterior or posterolateral technique, single level; lumbar [with or without lateral transverse technique]) and +22614 (-each additional vertebral segment [list separately in addition to code for primary procedure]).

Also report 22842 (Posterior segmental instrumentation [e.g., pedicle fixation, dual rods with multiple hooks and sublaminar wires]; 3 to 6 vertebral segments) for the instrumentation and 20936 (Autograft for spine surgery only [includes harvesting the graft]; local [e.g., ribs, spinous process, or laminar fragments] obtained from same incision) for the bone graft.