Neurosurgery Coding Alert

Question: The surgeon performs lumbar decom-pression bilaterally at segments L4 and L5. At the same time, the surgeon performs microdiskectomy at the L4/L5 interspace. What is the proper coding?

Rhode Island Subscriber

Answer: Appropriate coding depends on exactly how the surgeon achieved decompression of the nerves.

If the surgeon removes the entire lamina (laminectomy), along with vertebral facets and foramina, you should report 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) for the first level (L4) and +63048 (... each additional segment, cervical, thoracic, or lumbar [list separately in addition to code for primary procedure] ) for the second level (L5).

The code descriptors for 63047 and 63048 specify "unilateral or bilateral" and, therefore, you needn't apply any modifiers (or expect any additional compensation) to describe the procedure as bilateral.

If, instead, the surgeon removes only a portion of the laminae, with diskectomy and/or facetectomy or foraminectomy at the interspace, report instead a single unit of 63030 (Laminotomy [hemilaminectomy], with decompression of nerve root[s], including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disk; one interspace, lumbar [including open or endoscopically assisted approach]).
 
Because 63030 does not specify "unilateral or bilateral," you may append modifier -50 (Bilateral procedure) to specify that the surgeon performed the work on each side of the interspace.

Regardless of whether you claim 63047/63048 or 63030-50, you cannot report a separate code for the microdiskectomy. Laminectomy and hemilaminectomy include diskectomy and, therefore, you cannot charge separately for this procedure. If the microdiskectomy adds significant time and effort to the laminectomy or hemilaminectomy, you might append modifier -22 (Unusual procedural services) to your claim, but you must have excellent documentation and a strong basis for appeal to expect payment.

Some non-Medicare payers will also allow payment for +69990 (Microsurgical techniques, requiring use of operating microscope [list separately in addition to code for primary procedure]) for use of the operating microscope, although more and more payers are bundling 69990 into neurosurgical procedures.
Rhode Island Subscriber