Neurosurgery Coding Alert

Test your coding knowledge.  Determine how you would code this situation before looking at the box below for the answer.
Question: The surgeon performed a lumbar decompression followed by a lumbar microdiskectomy at a different level. Each procedure was associated with a different diagnosis: 722.10 for the decompression, and 724.02 for the microdiskectomy. May I bill both procedures with modifier -59 attached to the latter?

Pennsylvania Subscriber
 

Answer: Yes, you may bill 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 63030 (laminotomy [hemilaminectomy], with decompression of nerve roots[s], including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disk; one interspace, lumbar [including open or endoscopically assisted approach]) together with separate diagnoses.
 
The national Correct Coding Initiative bundles these procedures, but the edit includes a "1" indicator. Therefore, modifier -59 (distinct procedural service) can be attached to the microdiskectomy to indicate that it was done at another location. Be sure to provide adequate documentation when submitting the claim, linking the diagnosis of 724.02 (spinal stenosis, lumbar region) with 63047, and 722.10 (displacement of lumbar intervertebral disc without myelopathy) with 63030 and clearly showing that the procedures were performed at different levels.
 
If, however, the surgeon extends the laminectomy to remove a disk at the adjacent level, modifier -59 may not be used because the procedure is not at a separate anatomical area. In this case, report the laminectomy (e.g., 63047) with modifier -22 (unusual procedural services) appended to account for the additional work of removing the disk. Be sure documentation clearly explains the service and the reasoning for the coding choice.