Neurosurgery Coding Alert

Question: A patient suffering from “thoracol. Spondylosis, no radiculopathy/myelopathy” reports to the neurosurgeon. They perform electrothermal annuloplasty on two levels. The first level is bilateral, and the second is unilateral. Should I use modifier 50 on the first level?

AAPC Forum Subscriber

Answer: You won’t need modifier 50 (Bilateral procedure) for this encounter. On the claim, report:

• 22526 (Percutaneous intradiscal electrothermal annuloplasty, unilateral or bilateral including fluoroscopic guidance; single level) for the first annuloplasty
• +22527 (… 1 or more additional levels (List separately in addition to code for primary procedure)) for the second annuloplasty
• M47.815 (Spondylosis without myelopathy or radiculopathy, thoracolumbar region) appended to 22526 and +22527 to represent the patient’s spondylosis.

Explanation: Modifier 50 isn’t needed in this situation because the descriptor indicates that you should use 22526 and +22527 whether the procedure is unilateral or bilateral. Remember, this doesn’t apply to all the codes you’ll encounter. If this specific indication about laterality is not made in the CPT^® code descriptor, then you should consider modifier 50 after consulting the code book and/or your payer.

Chris Boucher, MS, CPC, Senior Development Editor, AAPC