Neurosurgery Coding Alert

Question: Can I only report 63267 once? What if the patient had a synovial cyst at L3 and L4, and the doctor also had to perform a laminectomy at L5 for stenosis? What would be the most appropriate way to code this?


Arkansas Subscriber
 

Answer: If the stenosis is independent of the abscess, you should report 63267 (Laminectomy for excision or evacuation of intraspinal lesion other than neoplasm, extradural; lumbar) just once for the surgery the neurosurgeon performed on L3 and L4. Then, use 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) for the laminectomy.
 
Be sure to append modifier 59 (Distinct procedural service) to 63047 to indicate that the two surgical procedures were separate and distinct.

Usually, the codes for laminectomy and intraspinal lesion excision (63265-63290) are regional, covering however many levels there are in any spinal area (cervical, thoracic or lumbar). Whether you can separately code a decompressive laminectomy that your physician completes at an adjacent level for stenosis may depend on how unrelated the diagnoses are.

Clinical and coding expertise for You Be the Coder and Reader Questions provided by Eric Sandhusen, CHC, CPC, director of compliance for the Columbia University department of surgery.