Neurosurgery Coding Alert

Question: How should I code a posterior approach for a thoracic or lumbar corpectomy (transpedicular post-lateral approach)? I have been using 63055, but I feel that it does not reflect the work required for the corpectomy, which is usually bilateral.

New Mexico Subscriber  
Answer: Corpectomy codes 63055 (transpedicular approach with decompression of spinal cord, equina and/or nerve root[s] [e.g., herniated intervertebral disk], single segment; thoracic) and 63056 ( lumbar [including transfacet, or lateral extraforaminal approach] [e.g., far lateral herniated intervertebral disk]) are unilateral or bilateral.
 
Therefore, 63055 is correct for the procedure you cite, assuming the corpectomy was minimal and a nerve decompression was performed. If the procedure is unusually difficult (due to scarring from a previous procedure, for instance), you may earn additional payment by appending modifier -22 (unusual procedural services) to the claim, but be sure to support your coding with precise documentation.
 
Note: Although CMS will not allow modifier -50 (bilateral procedure) when appended to 63055 or 63056, some payers will reimburse for each side if you append HCPCS modifiers -LT (left side) and -RT (right side).
 
If the corpectomy was more extensive, you may instead report 63090 (vertebral corpectomy [vertebral body resection], partial or complete, transperitoneal or retroperitoneal approach with decompression of spinal cord, cauda equina or nerve root[s], lower thoracic, lumbar or sacral; single segment). Although the approach you describe is not included in the descriptor for this code, it is very close. Include documentation with the claim describing the procedure exactly as it was performed so the insurer can make an informed decision about payment.