Darlene Posted Wed 07th of March, 2012 20:12:22 PM
Can the neurosurgeon bill for both codes
63056 if both procedures are clearly documented in his Operative report? We have been getting denials for code 63030 stating it is mutually exclusive to 63056.
SuperCoder Answered Wed 07th of March, 2012 20:30:27 PM
These 2 codes are not mutually exclusive as per latest CCI.
If the access to the right far lateral disk requires a transpedicular approach as is usually the case, the appropriate code for the procedure you describe is 63056 (Transpedicular approach with decompression of spinal cord, equina and/or nerve root[s] [e.g., herniated intervertebral disk], single segment; lumbar [including transfacet, or lateral extraforaminal approach] [e.g., far lateral herniated intervertebral disk]) rather than 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]). The description for 63056 clearly includes a far lateral disk, and this is not bundled into code 63030, which may also be reported if the surgeon performs posterior approach and hemilaminectomy with decompression. The relative value units (RVUs) for 63056 (38.14) account for the additional work your surgeon mentions.
Even with a 50 percent increase in payment for appending modifier -22 (Unusual procedural services), reimbursement for 63030 (24.13 RVUs x 1.5 = 36.195 RVUs) is lower than that for 63056. If the surgeon did not perform a transpedicular approach, modifier -22 may be appended to 63030 only if additional time and effort were required.