Neurosurgery Coding Alert

Question: Our neurosurgeon used a transpedicular approach to complete bilateral spinal cord decompression for herniated intervertebral discs in the lumbar area. The payer won't accept bilateral modifiers with either code (for the single or additional segments). How should I indicate this on the claim? Vermont Subscriber Answer: The descriptor for 63056 (Transpedicular approach with decompression of spinal cord, equina and/or nerve root[s] [e.g., herniated intervertebral disc[s], single segment; lumbar [including transfacet, or lateral extraforaminal approach] [e.g., far lateral herniated intervertebral disc]) mentions "root(s)," which indicates one or both sides of the level -- and keeps you from reporting bilateral modifiers 50 (Bilateral procedure), LT (Left side), or RT (Right side). Another consideration: Code 63056 has a high relative value unit (RVU) assignment of 38.43. Considering this, it's understandable that the payer won't reimburse for it bilaterally.