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Question: Our orthopedic spine surgeon performed an extensive spine procedure. Due to a complication, a neurosurgeon was asked to come in and perform an incidental durotomy (ID). The neurosurgeon performed only the durotomy and scrubbed out. The spine surgeon continued with the rest of the spine procedure. The orthopedic spine surgeon is requesting that the neurosurgeon be the primary provider on the procedure.

Can you confirm if they can be co-surgeons on the durotomy code and not the spine procedure?

Oklahoma Subscriber

Answer: No, the orthopedic spine surgeon and the neurosurgeon cannot be co-surgeons on just the durotomy repair code.

Why not? The reason why the two providers cannot be co-surgeons is that the National Correct Coding Initiative (NCCI) manual forbids billing for the procedure altogether.

According to , 鈥淚f a dural (cerebrospinal fluid) leak occurs during a spinal procedure, repair of the dural leak is integral to the spinal procedure.鈥� The manual continues to instruct you to not report 63707 (Repair of dural/cerebrospinal fluid leak, not requiring laminectomy) or 63709 (Repair of dural/cerebrospinal fluid leak or pseudomeningocele, with laminectomy) separately for the repair. In short, you cannot bill the incidental durotomy in conjunction with the spine procedure.

An ID is a common complication that occurs during spine surgery. The condition can lead to leaking cerebrospinal fluid, which may result in additional complications like severe headaches, intracranial bleeding, and nerve root entrapment.

Mike Shaughnessy, BA, CPC, Development Editor, AAPC