Neurosurgery Coding Alert

Question: Our surgeon performed an L4, L5, S1 laminectomy to take several biopsies. What is the appropriate code for this procedure? North Carolina Subscriber Answer: Your options vary according to the results of the pathology report analyzing the biopsies the surgeon took. If the biopsy revealed a neoplasm, you should call on an appropriate excision of spinal lesion code (63275-63290) specific to laminectomy for biopsy/excision of intraspinal neoplasm. Because the surgeon addressed three levels across two regions, you may be able to support the application of modifier 22 (Increased procedural services) to the primary procedure code. But codes in the excision of intraspinal lesion range do not specify the number of levels that the surgeon addresses, so you should apply modifier 22 only if the surgeon provides documentation that the surgery was especially difficult or time-consuming. If the tissue was normal or if the surgeon found a lesion with no indication of a tumor, use instead exploration code 63017 (Laminectomy with exploration and/or decompression of spinal cord and/or cauda equina, without facetectomy, foramin-otomy or discectomy [e.g., spinal stenosis], more than 2 vertebral segments; lumbar). -- Technical and coding guidance for You Be the Coder and Reader Questions provided by Gregory Przybylski, MD, director of neurosurgery at the New Jersey Neuroscience Institute, JFK Medical Center in Edison.