Neurosurgery Coding Alert

Modifier indicator of '1' means you can break the bundle

You-re now faced with several new spine code bundles that will affect your laminotomy, laminoplasty and laminectomy claims, thanks to National Correct Coding Initiative version 12.1. The good news: You-ll be able to report the procedures together when the neurosurgeon performs them at different levels. Watch for Additional Procedures at Other Levels NCCI 12.1 targets cervical -open-door- laminoplasty procedures, which you report using codes 63050 (Laminoplasty, cervical, with decompression of the spinal cord, two or more vertebral segments) and 63051 (... with reconstruction of the posterior bony elements [including the application of bridging bone graft and non-segmental fixation devices [e.g., wire, suture, mini-plates], when performed]).

You won't be able to report these two codes with any cervical laminectomy procedures done for excision of intraspinal lesions (63250, 63265, 63270, 63275, 63280, 63285, 63290) or initial or recurrent cervical hemilaminotomies (63020, 63040).

-This is one coders will need to watch and utilize the 59 when appropriate,- says Annette Grady, CPC, CPC-H, healthcare consultant in Bismarck, N.D., and member of the AAPC National Advisory Board. Because the bundles have modifier indicators of -1,- you can append modifier 59 (Distinct procedural service) to the laminectomy or hemilaminotomy code if the neurosurgeon's documentation indicates that the procedures were separate.

Neurosurgeons perform cervical open-door laminoplasties for severe stenosis and may also perform a foraminotomy when the patient has foraminal stenosis or lateral disk herniation, Grady says. -The key will be watching for additional procedures performed at different levels of the spine that are unrelated to the stenosis or herniation.- You Won't Suffer Much Lost Reimbursement Although the NCCI lists over a dozen edits that affect spine codes, you probably won't suffer a big kick in the wallet from these new laminotomy/laminoplasty bundles. -The new edits should not affect our practice,- says Lisa St. Germain, CPC, coding specialist at Orthopaedic Specialists of the Carolinas. -We would only bill any combination of 63020, 63040 and 63050 code groups if the surgeon performed the surgeries at different vertebral levels.-
 
Example: Because laminectomy and laminoplasty are completely different procedures, surgeons probably wouldn't perform them at the same spinal level during the same session. If the surgeon performs the procedures at separate levels, you can append modifier 59 to the bundled code.

Tip: While NCCI doesn't bundle them, CPT instructs that you should not report 22600, 22614, 22840-22842, 63001, 63015, 63045, 63048, 63295 with 63050 or 63051 when a neurosurgeon performs them on the same level. Grady suggests adopting these guidelines as if they were NCCI edits, applying modifier 59 to the additional codes if documentation supports the service.