Neurosurgery Coding Alert

Question: When the neurosurgeon performs a bilateral laminotomy, can we apply modifier 50 to the laminotomy code?

Tennessee Subscriber

Answer: Yes, you can attach modifier 50 (Bilateral procedure) to bilateral laminotomies. CPT specifies that the laminotomy code set (63020-63044) is unilateral. Therefore, you can use the modifier to secure extra reimbursement when the neurosurgeon performs the procedure bilaterally.
 
For example, the surgeon removes the lower portion of the left and right laminae at C5 and the medial portion of both C56 facets, and then removes the lower portion of the left lamina at C6 and the medial portion of the left C67 facet. On the claim, you would report the following:
 
- 63020 (Laminotomy [hemilaminectomy], with decompression of nerve root[s], including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disc; one interspace, cervical) for the C5 lamina removal
 
-  modifier 50 attached to 63020 to show the insurer that the surgeon performed the procedure bilaterally
 
-  +63035 (- each additional interspace, cervical or lumbar [list separately in addition to code for primary procedure]) for the C6 lamina removal.
 
Explanation: The C5 laminotomies were bilateral. Because the surgeon only worked on the left hemilamina at C6, the C6 laminotomy was unilateral.