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 Subscriber

Answer: 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 foraminotomies (which would include the right L5S1 discectomy) OR 63030 (Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disc, including open and endoscopicallyassisted approaches; 1 interspace, lumbar) appended with the modifier -50 (Bilateral procedure.....) for bilateral L5-S1 foraminotomies and the right L5-S1 discectomy. The reported L3 partial laminectomy does not include a description of what, if anything, is being decompressed. If the surgeon performed this to expose above the prior scar tissue at L4-5, this would not be separately reportable. You append modifier -59 (Distinct procedural service....) to the subsequent code after 63042-50 to identify the separate anatomical level of surgery performed at L5-S1.