Neurosurgery Coding Alert

Question: How should I report a laminectomy at T12, L1 and L2 for resection of an intradural tumor?

Maryland Subscriber
 
Answer: The correct coding is 63286 and 63282-59 x 2. Codes 63275-63290 specify laminectomy for biopsy/excision of intraspinal neoplasm and apply to a single level. The appropriate codes are selected according to approach -- extradural (63275-63278), intradural (63280-63287) or combined (63290) -- and level -- cervical (63275, 63280 and 63285), thoracic (63276, 63281 and 63286), lumbar (63277 and 63282), sacral (63278 and 63283) and thoracolumbar (63287). The combined extradural-intradural approach, 63290, applies to any level.
 
The national Correct Coding Initiative, version 7.2, indirectly bundles 63282 to 63286, i.e., 63282 is bundled to 63281, which in turn is bundled to 63286. These edits include a 1 indicator, however, which means that modifier -59 (distinct procedural service) may be appended to show that the procedures were performed at different sites and therefore warrant separate reimbursement. Documentation should clearly demonstrate that the intraspinal lesion extended to several different levels.
 
Some payers, including Medicare carriers, may reject 63282 at multiple levels because they consider the laminectomy codes to be regional, i.e., a single code applies to procedures at multiple levels. Neither CPT nor CPT Assistant has directly addressed this issue. Some providers have successfully appealed these claims, however.