Neurosurgery Coding Alert

Question: When our surgeon completes a discectomy with fusion, Medicare pays the full amount for 22612, but inserts modifier 51 with 63047 and pays that line at 50 percent. Would the discectomy ever be considered separately identifiable, depending on what our physician finds during the case? And if modifier 59 is appropriate, would Medicare reimburse the fully allowed amount for that line? Montana Subscriber Answer: When your physician performs multiple procedures, Medicare pays the procedure with the most relative value units (RVUs) at 100 percent of the code's allowable rate. The carrier then reimburses additional stand-alone procedures at 50 percent, regardless of whether you report modifier 51 (Multiple procedures) or 59 (Distinct procedural service). In your case, 22612 (Arthrodesis, posterior or posterolateral technique, single level; lumbar [with or without lateral transverse technique]) contains more RVUs, which is why Medicare reimbursed it at 100 percent. The multiple procedure reduction applies to [...]