Neurosurgery Coding Alert

Question: When our neurosurgeon performs a lumbar disc excision he always pours over the nerve root the same medication that a pain management specialist administers for a steroid injection. We submit 63030 for the main procedure. Is there a CPT code for the medication wash, and can we bill for it?

New Jersey Subscriber

Answer: No, you cannot code separately for the medication wash you describe.

Explanation: National Correct Coding Initiative (CCI) edits bundle similar pain management procedures with 63030 (Laminotomy [hemilaminectomy], with decompression of nerve root[s], including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disc, including open and endoscopicallyassisted approaches; 1 interspace, lumbar). For example, CCI prevents you from reporting 64483 (Injection,anesthetic agent and/or steroid, transforaminal epidural; lumbar or sacral, single level) or other injection procedures with 63030. It also does not allow you to break the pairing with a modifier. Therefore, payers who follow CCI edits will consider pouring medication into a surgical wound to be part of the procedure and not separately billable.

Compare: In contrast, the insertion of a separate and distinct needle into the vertebral foramen is different physician work and malpractice risk as compared to "pouring" the medication into the surgical wound. Even though the end result is the same (the physician places the drug at the anatomic site), the physician work and risk are quite different, so they garner different reimbursement.