Neurosurgery Coding Alert

Answer: Susan Callaway-Stradley, CPC, CCS-P, a coding consultant and educator in North Augusta, S.C., says that 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) would include decompression of the spinal by any method, including 63030 (laminotomy [hemilaminectomy] with decompression of nerve root[s], including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disk; one interspace, lumbar [including open or endoscopically-assisted approach]).

The national Correct Coding Initiative (CCI) and the American Academy of Orthopaedic Surgeons (AAOS) lists 63030 as bundled into 63047 because 63030 includes removal or excision of osteophyte and/or hypertrophic facets. Because removal of a herniated disc is an optional component of 63030, you may not bill for that separately, either.

Eric Sandham, CPC, compliance educator for Central California Faculty Medical Group, a group practice and training facility associated with the University of California at San Francisco in Fresno, suggests attaching modifier -22 (unusual procedure services) to 63047 to request additional reimbursement under these circumstances. A report may be appropriate to explain why the service provided was greater than that usually listed for the procedure.

Surgeries like this often are performed to relieve compres-sion of the spinal cord caused by a bone displaced in an injury or accident or degeneration of a disc. Fusion occasionally is needed.

Carriers may not understand the differences between laminotomies and laminectomies and why it may be necessary to perform both procedures in tandem. The laminotomy is the excision of the upper and lower portions of adjacent laminae (e.g., at the interspace), while a laminectomy is removal of the entire lamina from a single segment. When the doctor does a laminectomy, it is not always possible to reach that disc with only that procedure, Sandham explains. Neurosurgeons often must remove part of the spinous process above or lamina below the excised level to gain full access.

Sandham reports that he has had cases, on appeal, in which third-party carriers allowed a greater reimbursement with the -22 modifier to compensate for the performance of both procedures and the discectomy and removal of HNP. Coders should keep in mind, however, that third-party payer policies will vary from carrier to carrier and state to state, and that reimbursement when using modifier -22 under these circumstances also will vary. As suggested in the definition of modifier -22, a report submitted with the claim explaining why the service provided was greater than usually listed may prove helpful.