Neurosurgery Coding Alert

Question: The neurosurgeon performs a re-exploration microdiskectomy at level L4-5 (unilateral) and an initial microdiskectomy at L5-S1 (unilateral) during the same session. Medicare won't reimburse 63030 and 63042 during the same operation. In addition, +63035 (Laminotomy; ... each additional interspace) may be claimed with 63030 only: There is no way to report "additional levels" with 63042. What are the proper codes for this procedure? What is proper if laminectomy is performed at multiple levels? Michigan Subscriber Answer: The national Correct Coding Initiative (CCI) bundles 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]) and 63042 (Laminotomy [hemilaminectomy], with decompression of nerve root[s], including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disk, reexploration, single interspace; lumbar), but if the procedures are performed at different levels (as you indicate), you can nullify the edits by appending modifier -59 (Distinct procedural service) to the secondary code, in this case 63030.

And because 63042 and 63030 are unilateral codes, modifier -59 may also be attached to unbundle these procedures if they are performed on separate sides at the same vertebral level. In either case, modifier -59 indicates to the payer that the re-exploration occurred at a separate anatomic site and therefore should not be included in the initial microdiskectomy. To code correctly for a reoperative laminectomy at multiple levels, report +63043 ( each additional cervical interspace [list separately in addition to code for primary procedure) or +63044 ( each additional lumbar interspace), as appropriate. Note, however, that CMS generally does not recognize 63043 and 63044 because it considers these codes to be "bundled" to 63042, i.e., reoperative laminotomies are "regional" procedures, including all levels in that spinal area.

Because of this bundling by Medicare and certain other payers, some neurosurgeons still report 63042-51 (Multiple procedures) for each additional level. But if you choose this method you will likely have to appeal. In making your case, be sure to note that prior to the new codes for additional levels, billing for each level with 63042-51 was allowed and that there was no adjustment to the RVUs for 63040-63042 commensurate with their new "regional" definition.

If either 63040 (... cervical) or 63042 is performed bilaterally (on both sides at the same vertebral level), report the appropriate code with modifier -50 (Bilateral procedure) attached, on either one (63042-50) or two (63042, 63042-50) lines, as requested by the payer. Bilateral procedures are generally automatically reimbursed at 150 percent of the rate of the unilateral procedure.