Neurosurgery Coding Alert

You can report laminectomy and laminotomy together, if required If the surgeon extends a bilateral or unilateral cervical laminectomy significantly above or below the targeted segment to remove part of an adjacent segment and performs a diskectomy, you may report both the laminectomy and the laminotomy. However, you will have to append modifier -59 (Distinct procedural service) to indicate that the laminotomy was a separate, required procedure.
 
"If both a laminectomy and a laminotomy are performed on the spine at different levels, then it would be appropriate to report a separate code for each of the procedures," according to the AMA's CPT Assistant (February 2001).
 
Example: The surgeon removes the left lamina of segment C5, the left and right lamina of segment C6, and the right lamina of segment C7. In addition, he removes a significant portion of the lower left lamina of segment C4 to ease access for a diskectomy at C4/C5. To report the service, assign 63045 (for the unilateral laminectomy at C4),    63048 x 2 (for the bilateral laminectomy at C6 and unilateral laminectomy at C7), and 63030-51-59 (for the laminotomy with diskectomy at C4/C5). Modifier -22 Provides Another Option As an alternative, you may append modifier -22 (Unusual procedural services) to the appropriate laminectomy code to identify the procedure as more extensive than usual and forgo reporting the laminotomy.
 
In this case, coding for the above example is 63045-22, 63048 x 2. Be sure to include supporting documentation to justify the claim, along with a request for additional reimbursement commensurate with the increased effort.