Neurosurgery Coding Alert

Question: Two neurosurgeons work for the same practice. Surgeon A performs a cervical decompression (63075), and B performs the arthrodesis (22554), instrumentation and graft. How should we code this? Should we bill the arthrodesis with modifier -51? Should we always expect a 50 percent reduction for the arthrodesis?

Connecticut Subscriber  
Answer: In this case -- because both surgeons are of the same specialty and work for the same practice -- bill as if a single surgeon performed the surgery. Arthrodesis may be performed in the absence of other procedures and, therefore, when it is combined with another definitive procedure, modifier -51 (multiple procedures) is appropriate. A 50 percent reduction in fee is customary when modifier -51 is attached to the procedure.
 
The correct coding is 63075 (diskectomy, anterior, with decompression of spinal cord and/or nerve root[s], including osteophytectomy; cervical, single interspace) for the first surgeon and 22554-51 (arthrodesis, anterior interbody technique, including minimal diskectomy to prepare interspace [other than for decompression]; cervical below C2) for the second. The second doctor may also report the appropriate instrumentation and graft codes without modifier -51. Payment for these procedures already reflects their status as secondary services.
 
Do not be mislead into believing that because these are different procedures performed by different physicians, they should be billed as sequential surgeries, as defined by the Medicare Carriers Manual (MCM), section 4828.A. The MCM specifically states that sequential surgeries may be billed only when surgeons of different specialties performed separate procedures. If the second surgeon was
an orthopedic surgeon, for example, he or she could charge for the fusion using 22554 without appending modifier -51. Because both surgeons here are neurosurgeons, billing without modifier -51 appended to the secondary procedure would be seen as an attempt to circumvent the multiple-procedure guidelines.