Orthopedic Coding Alert

Question: I've gotten a denial from Medicare saying that 63044 is bundled with 63042. Yet I thought 63044 was an add-on code. Is this correct?

Ohio Subscriber

Answer: According to the Medicare Fee Schedule, 63044 (laminotomy [hemilaminectomy], with decompression of nerve root[s], including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disk, re-exploration, single interspace; each additional lumbar interspace [list separately in addition to code for  primary procedure]) has a status of "B" for bundled. Medicare does not recognize this code, even though CPT indicates in can be billed in addition to the major procedure, in this case 63042 (laminotomy [hemilaminectomy], with decompression of nerve root[s], including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disk, re-exploration, single interspace; lumbar).
 
For the extra work involved in a multilevel revision laminectomy, your only option with Medicare is to submit 63042 with modifier -22 (unusual procedural services) and supporting documentation.