Neurosurgery Coding Alert

If your spine surgeon performs bilateral surgeries such as lumbar laminotomies (63030), you should append modifier -50 (Bilateral procedure) to the procedure code and double the charges rather than reporting multiple units. Coders who follow this rule will be well prepared to report complex procedures, such as bilateral laminotomies, on several levels.
 
Because 63030 (Laminotomy [hemilaminectomy], with decompression of nerve root[s], including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disk; one interspace, lumbar [including open or endoscopically assisted approach]) refers to "one interspace," CPT directs surgeons to bill each additional interspace (a vertebral interspace is the nonbony compartment between two adjacent vertebral bodies) beyond the first using +63035 (... each additional interspace, cervical or lumbar [list separately in addition to code for primary procedure]).
 
"Our surgeon performed bilateral laminotomies on two levels, so we billed [a commercial payer] 63030 on one line and 63030-50 on the next, followed by two units of 63035," says Stacey Kriser, billing administrator at Spine Associates PC in Minneapolis. "We got paid much less than expected, though, because they saw that both line items of 63035 referred to the same spinal level, so they disallowed the second unit. Later we learned that we could also bill 63035 bilaterally."
 
You should bill lumbar laminotomies performed bilaterally on four levels as follows, says Annette Grady, CPC, CPC-H, director of reimbursement at the Bone and Joint Center in North Dakota and the chairwoman for the North American Spine Society's administrative task force:

  63030-50 (for the first level - double your fee)
  63035-50 x 3 (for the additional three levels). Place the "3" in the claim form's "units" field, and increase your fee because each unit is bilateral. Grady says that this is the correct billing method for CMS and many Blue Cross carriers, but you should always check with your workers' compensation and commercial carriers to confirm how they prefer bilateral procedures to be reported.
 
"On your claim form, indicate the levels that the surgeon addressed, or send along the operative report," Grady says. "Unless the surgeon actually uses the word 'bilateral' in his notes, always double-check to determine whether he addressed each level bilaterally."
 
If the surgeon performs four unilateral levels of laminotomy, you would report 63030 with either modifier -LT (Left side) or -RT (Right side) to indicate the side the surgeon addressed, and 63035 x 3 (with the -LT or -RT modifier appended), Grady says. Know Your Anatomy for Arthrodesis Suppose the surgeon's notes indicate anterior fusion of L1 to L3. Many coders are tempted to bill one unit of 22558 (Arthrodesis, anterior interbody technique, including minimal diskectomy to prepare interspace [other than for decompression]; lumbar) and two units of +22585 (... each additional interspace [list separately in addition [...]