Coding Tactics to Get Paid for Laminectomies- Published on Tue, May 01, 2001
"Obtaining reimbursement for laminectomies is often difficult because of confusion regarding which codes to use and whether they are bundled. These are expensive and complex procedures, and an incorrect determination can cost practices considerable amounts of money.
The case studies below illustrate coding that was denied or reduced. 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, tells why and how they can be corrected.
Case Study #1: Re-operative Laminectomy
A coder reads an operative report that states the following procedures were performed:
Laminectomy, Ll-2 and L2-3 bilateral re-exploration;
Lysis of adhesions;
Foraminotomy, Ll-2, L2-3, L3-4 and L4-5 bilaterally; and
Diskectomy, L3-4 left.
It was coded as follows:
63047 (laminectomy, facetectomy and foraminotomy [unilateral or bilateral with decompression of spinal cord, cauda equina and/or nerve root(s), ([e.g., spinal or lateral recess stenosis]), single vertebral segment; lumbar);
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]) -LT (left side) with modifier -51 (multiple procedures);
+63048 (... each additional segment, cervical, thoracic, or lumbar); and
+63035 (... each additional interspace, cervical or lumbar).
When the explanation of benefits (EOB) was received from Medicare, reimbursement for 63047, 63048 and 63035 was greatly reduced, and 63030 was not paid.
Sandham, a coder who specializes in neurosurgical procedures, explains that the main problem is that the re-exploration code was overlooked. The following is correct coding:
63042 (laminotomy [hemilaminectomy], with decompression of nerve root[s], including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disk, reexploration, single interspace; lumbar) with modifier -50 (bilateral procedure) appended for the bilateral re-operative laminectomy; a second charge of 63042 and modifier -51 appended for the re-operative laminectomy performed at L1-2 and L2-3.
Even though only a diskectomy was performed at L3-4 on the left side, bilateral foraminotomies were also done, and those procedures should be billed as:
63030 with modifiers -50 and -51 for the L3-4 hemilaminectomy and bilateral foraminotomy; and
63035 with modifier -50 for the additional bilateral level.
There are two problems here, according to Sandham: First, the surgeon did not clearly state in the operative notes the additional levels of hemilaminectomy that were performed, just the additional levels of foraminotomy. Also, while CPT 2001 has added new codes for additional levels of re-operative laminectomies (63043 and 63044), Medicare considers these bundled, therefore coders should apply the guidelines previously in effect.
Coders need to be careful when billing 63047