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Coding Corner: Reporting Multiple Spinal Surgeries With 1 method?

Unique procedures have unique requirements

When you're reporting multilevel spinal surgeries, such as spinal lesion excisions, laminotomies and laminectomies, remember that CPT applies three different sets of criteria for these services. To familiarize yourself with the requirements of each category of multilevel/segment codes and improve your coding accuracy, check out these examples.
Example #1: Lumbar Laminotomy
The Procedure: Due to progressive spinal degeneration with sciatica, the patient requires laminotomy (hemilaminectomy) and nerve root decompression at interspaces L1/L2, L2/L3 and L3/L4.
What to Report: Code 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]) for the initial interspace (L1/L2) and two units of +63035 (... each additional interspace, cervical or lumbar [list separately in addition to code for primary procedure]) for the two additional interspaces (L2/L3, L3/L4).
Expect Full Payment for 'Each-Additional' Codes
When reporting multilevel spinal surgeries that require "each-additional" codes, such as 63035 in the above case study, you should not append modifier -51 (Multiple procedures) to the additional codes, nor should you accept reductions for the additional levels, says Cathy Klein, LPN, CPC, president of Klein Consulting in Muncie, Ind. Note that in the facility setting, status indicator "T" procedures are subject to the 50 percent multiple-procedure discount when performed in conjunction with other procedures.
Example #2: Cervical/ Thoracic Laminectomy
The Procedure: To correct spinal stenosis, the physician performs laminectomy across four spinal levels, from the fifth cervical vertebra to the first thoracic vertebra (C5-C6-C7-T1).
What to Report: Code 63015 (Laminectomy with exploration and/or decompression of spinal cord and/or cauda equina, without facetectomy, foraminotomy or diskectomy [e.g., spinal stenosis], more than two vertebral segments; cervical) only.
Common Mistakes to Avoid: You should not code "one or two" segment codes at the same time as "more than two" segment codes or assign one code each for separate spinal areas (cervical, thoracic or lumbar).
Use One Code to Describe 'Range' Procedures
When coding procedures that use descriptors describing a range of spinal levels or segments, such as 63001 (Laminectomy with exploration and/or decompression of spinal cord and/or cauda equina, without facetectomy, foraminotomy or diskectomy [e.g., spinal stenosis], one or two vertebral segments; cervical), you should report one code only, regardless of the number of spinal segments the physician treats, Klein says.
Likewise, if the surgery spans more than one vertebral area (for instance, cervical and thoracic or thoracic and lumbar), you should select a single code that best describes where the physician performed the majority of the work, according to the North American Spine Society's Common Coding Scenarios.
Coding example: [...]

- Published on 2005-03-22