Neurosurgery Coding Alert

Question: What code would you use for a posterior thoracic microdiskectomy?

Florida Subscriber

Answer: Diskectomies performed in the thoracic region are done anteriorally. There is no specific code for this, but 64999 (unlisted procedure, nervous system) is recommended. It will indicate to the carrier that manual evaluation will be needed to correctly process the bill.

Provide thorough documentation of the procedure, including if it was performed percutaneously or as an open surgery. You may consider referencing 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) or 63046 (laminectomy, facetectomy and foraminotomy [unilateral or bilateral with decompression of spinal cord, cauda equina and/or nerve root[s], [e.g., spinal or lateral recess stenosis]), single vertebral segment; thoracic) as these procedures may include the same amounts of work and reimburse at a similar rate.

Specific carriers may request that you not use 64999, but it is always best to begin with the unlisted code rather than an incorrect one and appending modifier -22 (unusual procedural services). Some carriers ignore modifiers and if this occurs, you may be accused of billing for a service you did not provide and a recurring pattern of this could leave you open to an audit.


Answers provided by Kathleen Pride, CPC, CCS-P, coding supervisor at Martin Memorial Health Group in Port St. Lucie, Fla.; Eric Sandham, CPC, compliance educator for Central California Faculty Medical Group, a group practice and training facility associated with the University of California at San Francisco in Fresno, a coder who specializes in neurosurgical procedures; Andrea Lamb, CPC, at St. Josephs Medical Center, a multispecialty practice in Buckhannon, W.Va.; and Laurie Castillo, MA CPC, president of Physician Coding and Compliance Consulting, a physician consulting firm in Manassas, Va.