Neurosurgery Coding Alert

Question: Our neurosurgeon worked with an orthopedic surgeon during a patient's spinal fusion. The neurosurgeon performed the decompression and they worked as co-surgeons for the fusion. The orthopedist completed the instrumentation, but our neurosurgeon assisted. How do we bill for the neurosurgeon's part in the surgery?

North Dakota Subscriber

Answer: Start by reporting the decompression with 63001 (Laminectomy with exploration and/or decompression of spinal cord and/or cauda equina, without facetectomy, foraminotomy or discectomy [e.g., spinal stenosis], 1 or 2 vertebral segments; cervical) and the fusion with 22590 (Arthrodesis, posterior technique, craniocervical [occiput-C2]).

The correct code for the instrumentation is +22840 (Posterior non-segmental instrumentation [e.g., Harrington rod technique, pedicle fixation across one interspace, atlantoaxial transarticular screw fixation, sublaminar wiring at C1, facet screw fixation] [Listseparately in addition to code for primary procedure]), which CMS states has a payment status indicator of 1 for co-surgery. This means that co-surgeons could be paid for the procedure, but you'll need supporting documentation to establish the medical necessity for two surgeons.

Modifier heads-up: Because the fusion procedure is considered co-surgery, you might be tempted to automatically append modifier 62 (Two surgeons) with your documentation. CPT rules, however, state that the cosurgery modifier is not applicable to spinal instrumentation codes. Therefore, you can use only modifier 80 (Assistant surgeon) to describe the work of someone assisting at instrumentation placement.