Neurosurgery Coding Alert

Question: Our neurosurgeon performed a L2-3, L3-4 revision laminectomy (63047 and 63048) and placed the iliac screws (22848). The orthopaedic surgeon performed L3 pedicle subtraction osteotomy (22207), L1 and L4 smith peterson osteotomy (22214, 22216), L3-4 posterior interbody fusion (22630), removal of L3,4,5,S1 and iliac screw,(22852), replaced L4,L5,S1 screws, new screws placed at T12,L1,L2(22843).

Both physicians assisted each other with their parts of the procedures. Procedure codes 63047 and 63048 performed by our physician are bundled with the 22207, 22214, 22216, 22630 performed by the orthropaedic surgeon.

Should I report codes 63047 and 63048 as the primary procedure with 22207-82, 22214-82, 22216-82, 22630-82 or should I bill the assist codes only?

California Subscriber

Answer: Because both the osteotomy codes and the posterior interbody fusion code include the physician work of decompression at the same level(s), codes 63047 (Laminectomy, facetectomy and foraminotomy [unilateral or bilateral with decompression of spinal cord, cauda equina and/or nerve root(s), (e.g., spinal or lateral recess stenosis)], single vertebral segment; lumbar) and 63048 (...each additional segment, cervical, thoracic, or lumbar [List separately in addition to code for primary procedure]) can only be reported at separate and distinct anatomical locations from the osteotomy and interbody fusion.

The L34 decompression is bundled into the interbody fusion and the L23 decompression is bundled into the pedicle subtraction osteotomy. Since by definition both surgeons performed portions of the interbody fusion (22630, Arthrodesis, posterior interbody technique, including laminectomy and/or discectomy to prepare interspace [other than for decompression], single interspace; lumbar) and the pedicle subtraction osteotomy (22207, Osteotomy of spine, posterior or posterolateral approach, 3 columns, 1 vertebral segment [e.g., pedicle/ vertebral body subtraction]; lumbar), it would be appropriate for both surgeons to report these codes with the -62 cosurgery modifier. The modifier could also be applied to the Smith Peterson osteotomies if the neurosurgeon also worked as a co-surgeon with the orthopedist.

In addition, since many of the screws were replaced rather than having new ones placed, you should report either the reinsertion of spinal fixation device (22849, Reinsertion of spinal fixation device) or the placement of posterior instrumentation 7-12 segments (22843, ...7 to 12 vertebral segments [List separately in addition to code for primary procedure]) but not both.