Neurosurgery Coding Alert

Question: Our neurosurgeon performed a laminectomy and repaired a dural tear at the same level. Can we report a separate code, or is the repair part of the surgical global package?


Kansas Subscriber

Answer: A neurosurgeon cannot normally bill additional codes for complications such as this during surgery. In this case, the carrier will consider a small repair of the dural tear part of the laminectomy surgical package.

If the neurosurgeon repaired a more significant tear, however, you can append modifier 22 (Unusual procedural services) to the appropriate laminectomy code. For example, if he had to perform a repair requiring additional bone removal for exposure and/or graft application, you should use modifier 22.

Ask your physician to write a letter detailing the aspects of the procedure that went above and beyond a normal laminectomy procedure, and submit it with your claim to support your use of modifier 22.