Neurosurgery Coding Alert

Answer: Heidi Stout, CPC, a coder at University Orthopaedic Associates in New Brunswick, N.J., says the series of codes for spinal laminectomy (63250-63282) has no specific codes to report each additional segment. If you and your surgeon feel that 63287 (laminectomy for biopsy/excision of intraspinal neoplasm; intradural, intramedullary, thoracolumbar) is appropriate for reporting the surgery performed, but also feel that the work was above and beyond what is normally associated with this surgery, modifier -22 (unusual procedural services) should be reported when the service rendered is greater than that usually associated with the listed procedure. A strong argument could be made that this would apply to a multi-level laminectomy when no mechanism exists for reporting the additional levels. Remember that when you report the -22 modifier, you must submit supporting documentation with your claim that explains, preferably in laymans terms, the extent of the additional work involved. Be specific and dont hesitate to suggest to the carrier what level of reimbursement your physician feels is appropriate for the service rendered.

Eric Sandham, CPC, compliance educator for Central California Faculty Medical Group, a group practice and training facility associated with the University of California at San Francisco in Fresno, and a coder specializing in surgical and neurosurgical procedures, points out that this is a controversial topic in neurosurgical coding. Sandham says that the American Medical Association has given no clarification on whether these codes include multiple levels or not.

Sandham says, If the code were designed to represent multiple levels, it might so indicate (as does code 63015, laminectomy ... two or more levels). Sandham points out that this code range does not indicate single level or each level. The Medicare fee schedule database does, however, have a 2 in the multiple procedures field, indicating that multiple levels may be individually billed.

Note: 2 is defined as Standard payment adjustment rules for multiple procedures apply. If procedure is reported on the same day as another procedure with an indicator of 1, 2, or 3, rank the procedures by fee schedule amount and apply the appropriate reduction to this code (100%, 50%, 50%, 50%, 50% and by report). Base the payment on the lower of (a) the actual charge, or (b) the fee schedule amount reduced by the appropriate percentage.

Sandham adds that inconsistent rulings from administrative law judges have further clouded this issue. Some have allowed payment for additional levels while others have not. As there are variations in policy from carrier to carrier in state to state, it is always advisable to communicate directly with your local carriers on this or any other questionable issue.