Neurosurgery Coding Alert

Question: How should I report a retroperitoneal approach and resection of an L3/L4 schwannoma (benign) outside the neural foramina, between the psoas and vertebral bodies?

North Carolina Subscriber

Answer: Although the approach is difficult and goes to the bone, from your description there appears to be no bone removal. Because the surgeon did not remove bone, you should not code an excision of a vertebral body. The surgeon also did not perform a laminectomy. He or she only removed a tumor and, therefore, you should use the somatic nerve incision codes, specifically 64792 (Excision of neurofibroma or neurolemmoma; extensive [including malignant type]) with a diagnosis of 225.4 (Benign neoplasm of brain and other parts of nervous system, spinal meninges).

Append modifier -22 (Unusual procedural services) to reflect the extra work involved in the approach. Be sure to include thorough documentation with the claim to justify the modifier, as well as a cover letter requesting additional payment.