Neurosurgery Coding Alert

Question: If our neurosurgeon performs a laminectomy and repairs a dural tear at the same level, can we report a separate code, or is the repair part of the surgical global package?

Missouri Subscriber

Answer: The neurosurgeon normally cannot bill additional codes for such complications during surgery. In this case, the payer will consider repair of a small dural tear part of the surgery package.

But if the surgeon must perform a significant repair -- such as one that requires additional bone removal for exposure and/or graft application -- you can append modifier -22 (Unusual procedural services) to the appropriate laminectomy code.

You should ask the surgeon to write a letter detailing the aspects of the procedure that went above and beyond a normal laminectomy.