Neurosurgery Coding Alert

Question: When one of our neurosurgeons performs an anterior lumbar fusion and a radical discectomy, he wants to code the discectomy as unlisted. But another neurosurgeon in our practice reports the procedure with 22558 (Arthrodesis, anterior interbody technique, including minimal discectomy to prepare interspace [other than for decompression]; lumbar) and a 22 modifier (Increased procedural services). Both use modifier 62 because they have the general surgeon do the approach. Code 22558 does include "minimal discectomy" in the descriptor, therefore when our neurosurgeons do a radical discectomy, we feel the 22 modifier would be the best way to code. Would you please be able to verify the correct way or guide me to some policy on this?

Answer: The discectomy for interbody fusion is bundled into 22558. Many would consider the discectomy required to properly prepare the interspace and end plates for fusion to be at least 85 percent of the work and therefore radical. If the surgeon documents that he performed a separately identifiable decompression of nerve(s) including visualization of the nerve(s), you would be able to report an unlisted code for the decompression or alternatively a -22 on 22558. The latter option is more likely to be considered payable, particularly given the bundling in 2011 of anterior cervical discectomy and arthrodesis when performed together.