Orthopedic Coding Alert

Question: Our surgeon performed a single-level bilateral revision decompression (63042-50) as well as a single-level bilateral decompression (63030-50). Can
we report both codes, and if so, should we append modifier -51? 

Alabama Subscriber

 
Answer: The National Correct Coding Initiative (NCCI) considers 63042 (Laminotomy [hemilaminectomy], with decompression of nerve roots[s], including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disk, re-exploration, single interspace; lumbar) and 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]) mutually exclusive codes.
 
You should report these codes together only if you perform the laminotomies in two separate interspaces. Modifier -51 (Multiple procedures) would not apply in this scenario, and you should instead append modifier -59 (Distinct procedural service) and send the insurer a copy of your operative report demonstrating exactly what the surgeon performed.
 
Because you performed two separate bilateral procedures, you are correct in appending modifier -50 (Bilateral procedure) to both codes. Your claim, therefore, will appear as follows:
 
63042-50
63030-59-50.