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Dural Repair

N

nyyankees

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Smithtown, NY
Is a dural repair separately billable when performed with a spinal fusion, lumbar decomprssion? The dural repair was done during the decompression. Thanks.
 
Dural repair

Typically no because the dura should not be opened during a lumbar decompression. If the dura is opened it's usually because of a complication (eg, incidental durotomy or dural tear). Therefore, repair of something you inadvertently did during the procedure is not separately billable.

Kim Pollock, RN, MBA, CPC
KarenZupko & Associates, Inc.
www.karenzupko.com
 
nyyankees said:
Is a dural repair separately billable when performed with a spinal fusion, lumbar decomprssion? The dural repair was done during the decompression. Thanks.
Click to expand...
kjpollock said:
Dural repair

Typically no because the dura should not be opened during a lumbar decompression. If the dura is opened it's usually because of a complication (eg, incidental durotomy or dural tear). Therefore, repair of something you inadvertently did during the procedure is not separately billable.

Kim Pollock, RN, MBA, CPC
KarenZupko & Associates, Inc.
www.karenzupko.com
Click to expand...
I had a question in this regard.

I understand that dural repair is not separately billable because it is incidental to the Surgery. Can we bill modifier 22 because of the durotomies?

Doctor did an ACDF (Anterior Cervical Discectomy and Fusion) and noted the following complication.
Durotomy X2; given the adherence of the disc to the dura the patient during decompression suffered two durotomies.

Can we add modifier 22 to 22551 and 22552? And should we add a diagnosis code for the complication?
 
WHAT IF THE CONDITION IS LIKE THIS... PATIENT COMES FOR DURAL/CSF LEKAGE FROM PREVIOUS FUSION SITE... PHYSICIAN PERFORMS REFUSION OF THAT AREA ALONG WITH CSF LEKAGE REPAIR WITHOUT LAMINECTOMY. CAN WE BILL BOTH FUSION ALONG WITH 63707? ANYONE PLEASE SUGGEST. THANK YOU
 
raghuveer1.singh@corrohealth.com said:
WHAT IF THE CONDITION IS LIKE THIS... PATIENT COMES FOR DURAL/CSF LEKAGE FROM PREVIOUS FUSION SITE... PHYSICIAN PERFORMS REFUSION OF THAT AREA ALONG WITH CSF LEKAGE REPAIR WITHOUT LAMINECTOMY. CAN WE BILL BOTH FUSION ALONG WITH 63707? ANYONE PLEASE SUGGEST. THANK YOU
Click to expand...
If if wasn't incidental it should most likely be reported separately. There may be a CPT Assistant about this, I don't have access to that right now.

NCCI Manual CHAPTER VIII https://www.cms.gov/files/document/08-chapter8-ncci-medicare-policy-manual-2026-final.pdf

12. If a dural (cerebrospinal fluid) leak occurs during a spinal procedure, repair of the dural leak is integral to the spinal procedure. CPT code 63707 or 63709 (Repair of dural/cerebrospinal fluid leak) shall not be reported separately for the repair. If a dural (cerebrospinal fluid) leak occurs during a skull base approach procedure, repair of the dural leak is integral to the skull base approach procedure. CPT code 61618 or61619 (Secondary repair of dura for cerebrospinal fluid leak) shall not be reported separately for the repair. If a dural (cerebrospinal fluid) leak occurs during a burr hole, craniotomy, or craniectomy procedure, repair of the dural leak is integral to the burr hole, craniotomy, or craniectomy procedure. CPT code 62100 (Craniotomy for repair of dural/cerebrospinal fluid leak)shall not be reported separately for the repair.
 
amyjph said:
If if wasn't incidental it should most likely be reported separately. There may be a CPT Assistant about this, I don't have access to that right now.

NCCI Manual CHAPTER VIII https://www.cms.gov/files/document/08-chapter8-ncci-medicare-policy-manual-2026-final.pdf

12. If a dural (cerebrospinal fluid) leak occurs during a spinal procedure, repair of the dural leak is integral to the spinal procedure. CPT code 63707 or 63709 (Repair of dural/cerebrospinal fluid leak) shall not be reported separately for the repair. If a dural (cerebrospinal fluid) leak occurs during a skull base approach procedure, repair of the dural leak is integral to the skull base approach procedure. CPT code 61618 or61619 (Secondary repair of dura for cerebrospinal fluid leak) shall not be reported separately for the repair. If a dural (cerebrospinal fluid) leak occurs during a burr hole, craniotomy, or craniectomy procedure, repair of the dural leak is integral to the burr hole, craniotomy, or craniectomy procedure. CPT code 62100 (Craniotomy for repair of dural/cerebrospinal fluid leak)shall not be reported separately for the repair.
Click to expand...
Thank you for your input. I am afraid still my actual concern is not much cleared. The scenario I mentioned is not intraoperative/incidental. Spinal fusion is done a week ago and now patient is coming back with diagnosis of CSF leak. Physician has to open up previous fusion site to get it repaired and do a refusion. In this case should we bill both refusion (22551) with 63707?
 
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