Neurosurgery Coding Alert

Question: Our patient had a LT lumbar discectomy in November 2010. He has had recurrent herniation at the same level, same side and is back for a revision laminotomy with discectomy. Should I report 63042 (Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disc, reexploration, single interspace; lumbar)? And does recurrent = reexploration?

California Subscriber

Answer: Code 63042 is only appropriate after the patient is out of the 90-day global period. Otherwise, you would use 63030 (Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disc, including open and endoscopically-assisted approaches; 1 interspace, lumbar) and append modifier -78 (Unplanned return to operating room...) and 76 (Repeat procedure or service by same physician or other qualified health care professional: it may be necessary to indicate that a procedure or service was repeated by the same physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 76 to the repeated procedure/service. note: this modifier should not be appended with e/m service) or 77 (Repeat procedure or services by another physician or other qualified health care professional: it may necessary to indicate that a basic procedure or service was reported by another physician or other qualified healthcare professional subsequent to the original procedure or service....)