Orthopedic Coding Alert

Spine surgeons who perform bilateral surgeries such as lumbar laminotomies (63030) should append modifier -50 (Bilateral procedure) to the procedure code and double their charges rather than report multiple units. Coders who follow this rule will be well prepared to report complex procedures, such as bilateral lamino-tomies, 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 orthopedists to bill each additional interspace 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 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, a three-orthopedist practice 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 63035 could also be billed bilaterally."

Lumbar laminotomies performed bilaterally on four levels should be billed 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 double your fee, since 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 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 one unit of 63030, indicating the side addressed (e.g., -LT for left side or -RT for right side), followed by 63035 (with the -LT or -RT modifier appended) on one line with a "3" indicated in the units field, Grady says. Know Your Anatomy 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 to code for [...]