Neurosurgery Coding Alert

Question: We performed a laminectomy at L4, L5 and S1. We thought we would be removing a lesion, but only performed several biopsies and closed. How should we code?

Tennessee Subscriber

Answer: Your coding options vary greatly depending on the pathology results from the biopsies. If the biopsy revealed a neoplasm, then it would be payable using an appropriate excision of spinal lesion code (63275-63290) specific to laminectomy for biopsy/excision of intraspinal neoplasm. If the tissue was normal or if a lesion was found with no indication of a tumor, use 63017 (laminectomy with exploration and/or decompression of spinal cord and/or cauda equina, without facetectomy, foraminotomy or diskectomy, [e.g., spinal stenosis], more than 2 vertebral segments; lumbar).

Considering the three levels and the two regions (lumbar and sacral) indicated in the question, it may be possible to charge an additional amount and append modifier -22 (unusual procedural services) if an excision of intraspinal lesion code is used. Codes in the excision of intraspinal lesion range do not specify the number of levels that may be addressed. If additional reimbursement is not given when the initial payment is received, consider appealing the claim.