Neurosurgery Coding Alert

Question: How should the following be coded: Decompressive thoracic laminectomy, T3-T10 with fenestration and excision of arachnoid cyst? 63271 is my first choice, but what about the other levels (the cyst extended through all levels)?.

Oregon Subscriber

Answer: Many carriers view 63271 (laminectomy for excision of intraspinal lesion other than neoplasm, intradural; thoracic) and other codes from this section as regional codes (i.e. reflecting however many levels are done in any one region, the cervical, thoracic or lumbar) even though there is no specific reference to this interpretation. This means that in the surgery presented, although eight levels were addressed, a carrier may only pay for one unit of the code.

Contact your carriers and ask if the additional levels may be paid separately with modifier -51 (multiple procedures) appended.

If the carrier refuses, append modifier -22 (unusual procedural services) and supply the operative report to convey the additional time and effort spent during the procedure. If a denial ensues, appeal the claim. Be sure to include a copy of the operative report. Appeals are regularly won for this scenario.