Neurosurgery Coding Alert

Question: One of our physicians performed a lumbar laminotomy on three interspaces. During the procedure, he had to use an operating microscope. Can we report the microscope use separately from the laminotomies?


Alabama Subscriber

Answer: Probably not, though it ultimately depends on whether the insurer abides by the National Correct Coding Initiative (NCCI). While CPT guidelines permit separate reporting of code +69990 (Microsurgical techniques, requiring use of operating microscope [list separately in addition to code for primary procedure]) with laminotomy codes, the insurer will not allow separate reporting if it observes NCCI.

On claims for insurers that recognize NCCI,

- report 63030 (Laminotomy [hemilaminectomy], with decompression of nerve root[s], including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disk; one interspace, lumbar [including open or endoscopically assisted approach]) for the first interspace.

- report add-on code +63035 (... each additional interspace, cervical or lumbar [list separately in addition to code for primary procedure]) x 2 for the second and third interspaces.

Exception: If the payer does not adhere to NCCI rules, you may be able to:

- report 63030 for the first interspace.

- report 63035 x 2 for the second and third interspaces.

- report 69990 for the microscope use.

Good idea: If you decide to report the microscope use, be sure to check your remittance to see whether the payer recognizes 69990 when you report it with 63030.