Neurosurgery Coding Alert

3 case studies illustrate the unique coding requirements of laminotomy, laminectomy and excision procedures If you're reporting multilevel spinal surgeries, such as spinal lesion excisions, laminotomies and laminectomies, you should know that CPT applies three different sets of criteria for these services. To familiarize yourself with the requirements of each category of multilevel/segment codes and improve your coding accuracy, review the following expert-approved case studies. Case Study #1 ("Each-Additional"Codes): Lumbar Laminotomy The Procedure: Due to progressive spinal degeneration with sciatica, the patient requires laminotomy (hemilaminectomy) and nerve root decompression at interspaces L1/L2, L2/L3 and L3/L4. What to Report: Code 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]) for the initial interspace (L1/L2) and two units of +63035 (... each additional interspace, cervical or lumbar [list separately in addition to code for primary procedure]) for the two additional interspaces (L2/L3, L3/L4). Common Mistakes to Avoid: You should not append modifier -51 to add-on codes or accept fee reductions for procedures occurring at multiple spinal levels. Expect Full Fee Schedule Value for 'Each-Additional'Codes When reporting multilevel spinal surgeries that require "each-additional" codes, such as 63035 in the above case study, you should not append modifier -51 (Multiple procedures) to the additional codes, nor should you accept fee reductions for the additional levels, says Cathy Klein, LPN, CPC, president of Klein Consulting in Muncie, Ind. Such codes are "modifier -51 exempt," according to CPT, and the Medicare fee schedule assigns relative value units (RVUs) accordingly. Payment example: The 2004 Medicare Physician Fee Schedule database assigns 23.04 RVUs to 63030 and 5.43 RVUs to 63035. If, as in case study #1, the surgeon performs laminotomy at three levels, compensation should equal (23.04 x 1) + (5.43 x 2), or 33.9 RVUs. Because the descriptor for the add-on code specifically states, "each additional interspace," the payer should reimburse both units of 63035 at full value. "If I bill add-on procedures, I do not append modifier -51 because I do not want the add-on codes to be reduced," says Fran Richmond, billing coordinator at the Neurosurgery Clinic in Eugene, Ore. "I've also found that if I list the same code more than once [for example, 63035 on two separate lines], the payer will deny all but the first code as duplicates. If I use a single line and change the 'units' box [for example, '63035 x 2'], however, the payer will reimburse properly."

Other procedures that follow similar guidelines: vertebro-plasty, 22520-22534; arthrodesis, 22554-22632; complete laminectomy, 63045-63048; anterior diskectomy, 63075-63078; corpectomy, 63081-63103; excision of anterior intraspinal lesion, 63300-63308; injections, 64470-64484. Study 2 ("Range"Codes): Cervical/Thoracic Laminectomy The Procedure: To correct [...]