Neurosurgery Coding Alert

Question: We are claiming for a patient with Ewings Sarcoma at L1 and a pathologic fracture at L1. We are billing codes 63102 (Vertebral corpectomy [vertebral body resection], partial or complete, lateral extracavitary approach with decompression of spinal cord and/or nerve root[s] [e.g., for tumor or retropulsed bone fragments]; lumbar, single segment) for corpectomy and 63277 (Laminectomy for biopsy/excision of intraspinal neoplasm; extradural, lumbar) for laminectomy. Are we correct in billing two primary codes for the same level? The diagnosis codes are different. NCCI does not bundle the two codes and allows the combination. AANS may not agree. Please advise.

Florida Subscriber

Answer: The lateral extracavitary approach is a posterior approach that includes exposure of the lamina and facet to mobilize the paraspinal muscles. The procedure includes removal of the vertebral body, transverse process, and facet. Often, a lamniectomy is also performed and would be considered incidental to the rest of the procedure and would not be separately reportable at the same spinal level. If laminectomy is performed at additional spinal levels, this would be separately reportable.