Neurosurgery Coding Alert

Question: How should I code the following: repeat bilateral lumbar laminectomy and foraminotomy L4-S1 with posterolateral fusion L4 to S1 with a harvested bone graft? Preoperative diagnosis per the operative report is instability. The first surgery was performed one year prior to the second.

Michigan Subscriber

Answer: Code 63042 (laminotomy [hemilaminec-tomy], with decompression of nerve root[s], including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disk, reexploration single interspace; lumbar) should be used rather than a laminectomy code because of the re-operative nature of the dissection. Although this may look like a single-level (L5) laminectomy with foraminotomies above and below, whatever bone is being removed now is the remnant from the initial laminotomy (and so it may just require a laminectomy, not laminotomy, to expose the nerve roots). For the L4/5 bilateral decompression, bill 63042-51-LT and 63042-51-RT. Modifier -51 (multiple procedures) is allowed under the Medicare Fee Schedule Data Base.

Use 22612 (arthrodesis, posterior or posterolateral technique, single level; lumbar (with or without lateral transverse techniques]) appended with the -51 for the fusion. For the bilateral decompression L5-S1, code 63042-LT-59 and 63042-RT-59 and 22614 ( each additional vertebral segment [List separately in addition to code for primary procedure]) for the second-level fusion. (Do not append 22614 with modifier -51 because it is an add-on code and modifier exempt.) Use 20936 (autograft for spine surgery only [includes harvesting the graft;] local [eg, ribs, spinous process, or laminar fragments] obtained from same incision) for the harvested bone graft.