Neurosurgery Coding Alert

Question: How should I code when the surgeon performs a lumbar decompression (63047), but an additional level is a redo? What if the first level is a redo but the additional levels are not?

Tennessee Subscriber

Answer: When the surgeon performs a redo laminectomy at any lumbar level, you should choose 63042 (Laminotomy [hemilaminectomy], with decompression of nerve root[s], including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disk, re-exploration, single interspace; lumbar) for the first level.
 
Reporting an additional, "initial" level is more challenging. You should not choose +63048 (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; each additional segment, cervical, thoracic or lumbar [list separately in addition to code for primary procedure]). The payer would likely reject this outright - even if you append modifier -59 (Distinct procedural service) - because CPT specifically instructs you to report 63048 only with 63045-63047.
 
You should code a concurrent laminectomy with facetectomy, foraminotomy and nerve root decompression performed at the same time using 63047 (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; lumbar), according to CPT Assistant (January 1999). Although CPT Assistant doesn't make any specific recommendation regarding modifier use, you should append modifier -59 (Distinct procedural service) to indicate that the surgeon performed the laminectomy at a separate level. Without modifier -59, National Correct Coding Initiative edits will cause the payer to deny payment for this part of the service.