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Documentation to Support Modifier 22
When performing spinal procedures, does documentation of obesity support the use of modifier 22?
Question:
When performing spinal procedures, does documentation of obesity support the use of modifier 22?
Answer:
Documentation of obesity alone does not support the use of modifier 22, however, additional information indicating the patient’s obesity resulted in a procedure that was technically more difficult, or required more time than normal (i.e., suggesting that the neck was thick, positioning was difficult, more time was spent), could support the use of modifier 22.
*This response is based on the best information available as of 4/24/25.
Synthetic Graft to Close Dura
After performing a craniotomy for tumor removal, the dura was repaired with a synthetic graft. What code is used for the synthetic graft?
Question:
After performing a craniotomy for tumor removal, the dura was repaired with a synthetic graft. What code is used for the synthetic graft?
Answer:
Repairing the dura after a craniotomy with a synthetic graft is included in the craniotomy code. No additional code is reported.
*This response is based on the best information available as of 4/10/25.
Primary Difference in Lumbar Laminectomy Codes
What is the primary difference between lumbar laminectomy CPT codes 63030 and 63047?
Question:
What is the primary difference between lumbar laminectomy CPT codes 63030 and 63047?
Answer:
The primary difference in use of these CPT codes is the diagnosis; CPT code 63030 is for removal of a disc due to herniation or degenerative disc disease and CPT code 63047 is for decompression of the nerve due to stenosis or spondylosis.
*This response is based on the best information available as of 3/27/25.
Vertebral Segment vs Motion Segment
What is the difference between a vertebral segment and a “motion segment”?
Question:
What is the difference between a vertebral segment and a “motion segment”?
Answer:
A vertebral segment represents a single vertebral bone with its associated articular processes and lamina. A “motion segment” refers to 2 vertebral segments and the vertebral interspace (non-bony compartment between two adjacent vertebral bodies) between.
*This response is based on the best information available as of 3/13/25.
Craniectomy for Tumor Resection
Patient had a posterior fossa craniectomy for excision of a mass which was consistent with metastatic tumor. Pathology results report the mass as a partially cystic metastatic tumor. What is the correct code 61518 or 61524?
Question:
Patient had a posterior fossa craniectomy for excision of a mass which was consistent with metastatic tumor. Pathology results report the mass as a partially cystic metastatic tumor. What is the correct code 61518 or 61524?
Answer:
The correct CPT code is 61518; a metastatic tumor is still a tumor even if it is partially cystic.
*This response is based on the best information available as of 2/27/25.
Stereotactic Navigation and Microscope
Patient had to be taken back to the OR a day after an open skull base procedure due to a cerebrospinal fluid leak, and the dura was repaired with a synthetic graft material. What is the correct CPT code for the repair, if it is separately reported, and do we need a modifier?
Question:
Our provider performed a craniotomy for 2 separate lesions, one parietal and one occipital, through two separate craniotomy exposures. Stereotactic navigation and the operating microscope were needed for both resections. We are coding for the separate lesions as 61510, 61510-59, but can we also bill 61781 and 69990 twice with modifier 59 since they were needed for each separate lesion?
Answer:
No, stereotactic navigation and the microscope can each only be billed once per operative session.
*This response is based on the best information available as of 2/13/25.