Wiki Spinal Surgery Help PLEASE

[candicane1010]

Our Neurosurgeon is generally very good with his coding, however I cannot get this code to pass through the edits. He wants to bill 63056,50 and my edit is stating that I cannot bill this code bilaterally. Please review below, any suggestions will be appreciated:

He was subsequently taken back to the operating room and placed under gereral endotracheal anesthesia and positioned in the kneeling position on the Andews frame. The lumbar region was prepped and draped in a sterile fashion and a midline incision was placed in scar from his prior lumbar surgery. Dissection was carried down bilaterally in a subperiosteal fashion to expose the L5-S1 interlaminar space bilaterally. Level localization was confirmed with the aid of an intraoperative radiograph. Once the correct level had been identified, the facet joints bilaterally of L5-S1 were exposed and the self-retaining retractor was placed. A significant amount of scar tissue was encountered as a result of his prior surgery, which was carefully dissected away. This appeared to be more adherent, more significant on the right side. Initially the right foraminotomy was carried out. The medical portion of the L5-S1 facet joint on the right was thinned out with the high-speed drill, and the scar tissue dissected from the bony edge. Once the foramen was entered into the pedicle, the L5 was palpated and the L5 nerve root initially uncovered in its proximal course and then followed out through the foramen. The nerve root was completely uncovered. Following identification of the nerve root, attention was paid to the L5-S1 disk at that side. The residual ligamentum flavum and scar tissue was dissected away exposing the disk space itself. A disk herniation was noted along with evidence of previous disk disruption likely as a result of the prior surgery. This was removed and a lateral bulge was encountered compressing the
Distally in the foramen. This was incised and resected. The bony osteophytes off the inferior aspect of the L5 endplate were then resected. Following completion of the foraminotomy and resection of the lateral diskherniation as well as osteophytectomy, the nerve root was completely mobile, free from any evidence of residual external compression. Hemostasis was achieved and attention was turned to the left L5-S1 foramen. Less scar tissue was encountered on the left. Once again, the medial aspect of the facet joint was removed with a high-speed air drill and the inferior aspect of the lamina of L5 was removed. The L5 nerve root was exposed in its trandfrominal course and followed laterally and unroofing the bone over the L5 nerve root. Attention was then turned to the disk space where once again lateral bulging disk was noted, which was incised and resected. Smaller osteophytes off the inferior endplate of the mobilization of the exiting L5 nerve root on the left. Following completion of this, palpation revealed no residual evidence of thecal sac compression or nerve root compression

 

[RebeccaWoodward*]

Medicare does not allow modifier 50 with this procedure and as you know, many carriers follow Medicare's edit's. I have, however, heard of other coders appending RT/LT (Commercial carriers) to this service if the documentation supported the intensity of the procedure. Be ready to appeal though. I wish I could tell you that I've personally submitted it this way. I've only had experience with this procedure when peformed unilaterally. Another route could be adding modifier 22 if the providers entire documentation reflects the requirements for this modifier.

 

[dpaige]

In the description of this code it says nerve root(s), which to me implies it could be for one or both and in checking the modifiers with Encoder Pro for this code -50 and LT/RT do not appear to be allowed. So this indicates, though not clearly in the description, that this is already a bilateral code. If the surgeon feels extra work was required for this procedure you could try adding the 22 modifier and increasing the fee.

Denise Paige, CPC-COSC