Neurosurgery Coding Alert

Question: Is there a CPT^® code for the resection of fractured facets? This procedure occurred in a return OR visit, post lumbar decompressive laminectomy. The neurosurgeon also performed dural repair during this procedure. However, the surgeon did not perform a laminectomy or laminotomy. He also did not place any rods for the stabilization of the fracture. My first thought was 22325, but I am not sure if this code is correct because it looks like rods or hooks are placed above and below the injury during this procedure. Can you please help me?

North Carolina Subscriber

Answer: Additional information is needed to most accurately respond to this question. Code 63047 (Laminectomy, facetectomy and foraminotomy (unilateral or bilateral with decompression of spinal cord, cauda equina and/or nerve root[s], [eg, spinal or lateral recess stenosis]), single vertebral segment; lumbar) describes laminectomy, unilateral or bilateral, and includes facetectomy, whether or not a facet fracture is present. Code 22325 (Open treatment and/or reduction of vertebral fracture(s) and/or dislocation(s), posterior approach, 1 fractured vertebra or dislocated segment; lumbar) describes treatment of a traumatic fracture or dislocation and is not applicable to the scenario you describe. Since there was a return to the operating room (OR) for resection of fractured facet(s) with dural repair, the implication is that a prior laminectomy resulted in a dural injury.

In this scenario, assuming that the patient is within the 90-day global period of the lumbar laminectomy, one could report dural repair without laminectomy using 63707 (Repair of dural/cerebrospinal fluid leak, not requiring laminectomy). Since fractured facets (presumably related to the original laminectomy) are removed, 63709 (Repair of dural/cerebrospinal fluid leak or pseudomeningocele, with laminectomy) for dural repair with laminectomy (which would include facet removal, if performed) may be most accurate. Either procedure would be appended with modifier 78 (Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period) for return to the operating room for a related procedure.