Neurosurgery Coding Alert

Question: How is the following procedure coded? An extensive decompressive laminectomy L2-L3, L3-L4, L4-L5 and L5-S1, and removal of ganglion cyst in L3-L4 and L4-L5 and intralaminal tie fixation L3-L4-L5.

Set Shahbabian, MD
Cincinnati


Test your coding knowledge. Determine how you would code this situation before looking at the box below for the answer.



Answer: Based on the information provided, code as follows: For the ganglion cyst at level L3-L4 and L4-L5 the correct code would depend on the location of the cyst. If it was extradural (outside the dura mater) then the code is 63267 (laminectomy for excision or evacuation of intraspinal lesion other than neoplasm, extradural; lumbar) with modifier -22 (unusual procedural services) to reflect the second level. If the cyst was intradural (enclosed in the dura), the code would be 63272 (laminectomy for excision of intraspinal lesion other than neoplasm, intradural; lumbar). In addition, the codes for removal of an intraspinal lesion include the laminectomy, and the coder cannot code for additional levels involved in the lesion removal.

In this case, the laminectomy done at the L2-L3 and L5-S1 level can be coded separately because the cyst was only at the L3-L4 and L4-L5 levels. Depending on the extent, the coder might also code 63005 (laminectomy with exploration and/or decompression of spinal cord and/or cauda equina, without facetectomy, foraminotomy or diskectomy, [e.g., spinal stenosis], one or two vertebral segments; lumbar, except spondylolisthesis) with modifier -51 (multiple procedures) for the L2-L3 and L5-S1 decompressive laminectomies.

If the tie fixation is a segmental fixation using sublaminar wires, code with 22842 (posterior segmental instrumentation [e.g., pedicle fixation, dual rods with multiple hooks and sublaminar wires]; three to six vertebral segments) but remember that it cannot be billed without the fusion codes, so reporting it alone would not be correct. It may be that no separate charge for the tie fixation can be allowed if no fusion was done, and it would also have to be reflected in the -22 modifier appended to 63267.