Neurosurgery Coding Alert

Question: Patient has herniated disc at the L4-5 and L5-S1 as well as neural foraminal stenosis bilaterally. The surgeon does redo L4-5 laminectomies and partial L3 laminectomy, left-sided L4-5 discectomy, right-sided L5-S1 discectomy, and bilateral L5-S1 neural foraminotomies, all from the same incision. How do we report this?Pennsylvania SubscriberAnswer: It is unclear from the scenario whether prior disc surgery was performed only at L4-5 and the purpose of the partial L3 laminectomy. Assuming prior disc surgery only at L4-5, you report 63042 (Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disc, reexploration, single interspace; lumbar) with modifier -50 (Bilateral procedure............) for re-exploration L4-5 bilateral laminotomies and L4-5 discectomy. You report either 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) for L5-S1 neural [...]