Neurosurgery Coding Alert

Question: Surgery was performed on a patient for an anterior lumbar diskectomy with interbody fusion and internal fixation. We cannot find a procedure code for interior lumbar diskectomy in the CPT 2000 manual. Can you suggest one?
Gail Knight
SG Culter, MD, Tampa

Answer: Eric Sandham, CPC, compliance educator for Central California Faculty Medical Group, a group practice and training facility associated with the University of California at San Francisco in Fresno, and a coder who specializes in surgical and neurosurgical procedures, states that there is no code for the anterior lumbar diskectomy with decompression. Usually, when lumbar nerve root decompression is done, it is from a more lateral angle by a transpedicular approach. This would be coded 63056 (transpedicular approach with decompression of spinal cord, equina, and/or nerve root[s]; lumbar [including
transfacet, or lateral extraforaminal approach] [e.g., far lateral herniated intervetebral disk]).

Anterior lumbar diskectomy is most commonly part of the approach for the fusion. It generally does not involve decompressing nerves, but instead the removal of disk material in preparation for the  placement of interbody graft. Under these circumstances, this service would be included in code 22558 (arthrodesis, anterior interbody technique, including minimal diskectomy to prepare interspace [other than for decompression]; lumbar) and not reported separately. If in fact the anterior lumbar diskectomy did include a nerve root decompression or posterior osteophytectomy, the neurosurgeon could either
report it separately using unlisted procedure code 64999 or add the -22 modifier (unusual procedural services) to the fusion code.