Neurosurgery Coding Alert

Question: How should we code for annulus repair (X-close) with a discectomy? Can we bill both procedures, or are they reported together?

Arizona Subscriber

Answer: CPT does not currently include a code for the X-close procedure, so your coding depends on  hether your neurosurgeon performed that procedure alone or along with discectomy.

Alone: When performed alone, code the X-close procedure with 22899 (Unlisted procedure, spine).

With: You'll code the discectomy instead, however, when your surgeon completes both procedures during the same session. In that case, report 63030 (Laminotomy [hemilaminectomy], with decompression of nerve root[s], including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disc, including open and endoscopically-assisted approaches; 1 interspace, lumbar) for the discectomy and X-close.

Don't forget to add a modifier for bilateral discectomy and X-close claims. When your surgeon completes a bilateral decompression, CPT instructs you to include modifier 50 (Bilateral procedure).