Neurosurgery Coding Alert

Question: My physician wonders why +63044 does not have any relative value units (RVUs); he thought it actually had a higher RVU value because of the additional work involved with performing a re-exploration. Can you help me explain this to him?

Virginia Subscriber

Answer: According to CMS guidelines, code +63044 (Laminotomy [hemilaminectomy], with decompression of nerve root[s], including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disc, reexploadminister ration, single interspace; each additional lumbar interspace [List separately in addition to code for primary procedure]) carries a payment status indicator of C. That means you're reporting an inpatient procedure that's not payable by the Outpatient Prospective Payment System (OPPS). Your carriers will "price" these procedures and their RVUs.

Comparison time: +63044 doesn't have RVUs, but some add-on codes for similar procedures do. Because of this, physicians might be tempted to report 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) or +63048 (... each additional segment, cervical, thoracic, or lumbar [List separately in addition to code for primary procedure]) for the original procedure because their associated add-on codes have RVUs.

Remember that your job is to accurately code the procedures your physicians perform, not submit claims based on the assumed reimbursement. Code based on the documentation in the patient's chart and nothing  else.

Consider: The Relative Value Update Committee hasn't valued +63044, so no RVU recommendations have been given to CMS. Once sufficient volume experience has been achieved, the committee will conduct a survey to value +63044 and similar add-on code +63043 (... each additional cervical interspace [List separately in addition to code for primary procedure]). Therefore, having an accurate assessment of how often you report these codes will be critical to ensuring appropriate values for both procedures are set.