Neurosurgery Coding Alert

Question: If the surgeon performs a laminectomy and must repair a dural tear at the same level, may we report a separate code, or is the repair part of the surgical global package? My payer has been denying these claims.

Oregon Subscriber Answer: Generally, a surgeon may not bill additional codes for routine complications during surgery. In this case, the payer will consider repair of a small dural tear a part of the surgery package.

But if the surgeon must perform significant repair, such as that requiring additional bone removal for exposure and/or graft application, you have two coding choices:   You may append modifier -22 (Unusual procedural services) to the appropriate laminectomy code to report the unusual effort involved or,
  If the surgeon feels that the repair was truly significant and much greater than routine, report 63707 (Repair of dural/cerebrospinal fluid leak, not requiring laminectomy) along with the laminectomy code (if an additional level of laminectomy is required, use 63709, Repair of dural/cerebrospinal fluid leak or pseudo-meningocele, with laminectomy).

For those payers that require it, be sure to append modifier -51 (Multiple procedures) to 63707 or 63709.