Neurosurgery Coding Alert

Question: The surgeon performed complete laminectomy with decompression and excision of epidural mass at L4, along with complete laminectomy at L5. He used an operating microscope. How should I report this?


New Mexico Subscriber


Answer: You should report the L4 laminectomy using 63277 (Laminectomy for biopsy/excision of intraspinal neoplasm; extradural, lumbar). This procedure also describes excision of the epidural mass.

Reporting the complete L5 laminectomy correctly is more of a challenge and may depend on your payer.

Medicare and other payers may consider the laminectomy with excision codes 63275-63290, including 63277, to be "regional" - meaning that a single code applies to procedures at multiple levels. Therefore, the payer may not reimburse for the "additional" laminectomy at L5, reasoning that it is included as a part of the excision at L4.

In the unlikely event that the L5 laminectomy is unrelated to the excision at L4, however, you should report the procedure separately using 63005 (Laminectomy with exploration and/or decompression of spinal cord and/or cauda equina, without facetectomy, foraminotomy or diskectomy [e.g., spinal stenosis], one or two vertebral segments; lumbar, except for spondylolisthesis). Be sure that the surgeon's documentation justifies the necessary and distinct nature of this "additional" laminectomy.

For use of the operating microscope with the laminectomy with excision (63277), you should report +69990 (Microsurgical techniques, requiring use of operating microscope [list separately in addition to code for primary procedure]).