Clarification for TLIF with Contralateral Posterior Fusion Using Robotic Navigation

Question:

I am looking for guidance on a Transforaminal Lumbar Interbody Fusion (TLIF) case using robot/navigation. Placing a posterior fusion on the contralateral side of the spine from the TLIF. He is using the robot to plan a "false" screw then using robot to drill the opposite facet and then place bone graft into the facet. It requires additional time both before and after procedure. Would this be coded as 22612 along with 22633?

Answer:

Thank you for your question. If the contralateral posterior fusion is performed at the same level as the TLIF and is considered part of the same interspace, then CPT 22633 alone should be reported. This code already includes both the posterior interbody fusion and the posterolateral fusion at a single level. Even if robotic navigation is used to access the contralateral facet and place bone graft, it does not justify separate coding with 22612. 

*This response is based on the best information available as of 9/25/25.

Is CPT 20660 separately reportable with 61313?

Question:

My surgeon wants to bill CPT 20660 and CPT 61313. Is 20660 appropriate to report in addition?

Answer:

Great question! Thank you for asking KZA!

If you review the CPT descriptor for CPT 20660, this is a designated separate procedure.

First, let’s review what a “separate procedure” is:

CPT Says: “Some of the procedures or services listed in the CPT codebook that are commonly carried out as an integral component of a total service or procedure have been identified by the inclusion of the term “separate procedure.” The codes designated as “separate procedure” should not be reported in addition to the code for the total procedure or service of which it is considered an integral component.

However, when a procedure or service that is designated as a “separate procedure” is carried out independently or considered to be unrelated or distinct from other procedures, report the code in addition to other procedures/services by appending modifier 59 to the specific “separate procedure” code. This indicates that the procedure is not considered to be a component of another procedure, but is a distinct, independent procedure. This may represent a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries).”

That said, this means in practice that if a code description includes the term “separate procedure,” if that procedure is in the same anatomic area as a more comprehensive procedure (for example, application of a headframe followed by a craniectomy), only the more comprehensive procedure, the craniectomy (61313), is reported.

*This response is based on the best information available as of 9/25/25.

Reporting Modifiers with Unlisted Codes

Question:

Can modifiers be reported with unlisted CPT codes?

Answer:

Yes, modifiers can be appended to unlisted CPT codes.

In 2024, CPT clarified this by updating the introduction guidelines for unlisted procedures and services. These updates were further explained in the January 2024 issue of CPT Assistant, which addressed the new and revised text and the standardization of reporting unlisted CPT codes across the CPT code set.

Illustration of modifiers that may be appropriately applied includes:

• Laterality modifiers – e.g., RT (right), LT (left)

• Bilateral procedure modifier – 50

• Role-based modifiers – e.g., 62 (two surgeons), 80 (assistant surgeon), 82 (assistant surgeon when qualified resident not available), AS (non-physician surgical assistant)

• Multiple or distinct procedure modifiers – e.g., 51 (multiple procedures), 59 (distinct procedural service)

• Global modifiers – e.g., 58 (staged or related procedure), 78 (return to operating room for related procedure), 79 (unrelated procedure or service)

This is not an all-inclusive list of modifiers that may be appropriately applied to unlisted CPT codes. For complete and up-to-date information, one should refer to current CPT guidelines and payer-specific policies.

Please note: Modifiers that describe an alteration of a service or procedure, such as modifier 52 (reduced services), are not appropriate for use with unlisted codes. The same applied to modifier 22 (increased procedural services).

*This response is based on the best information available as of 9/22/25.

Redo Laminectomy Denials (63042 & 63044)

Question:

I am having trouble coding a redo laminectomy. Most get denied, and my surgeon does them all the time. CPT codes 22633 or 22612 are usually the primary codes. I'm still confused about 63042 & 63044. Thank you.

Answer:

Thank you for asking KZA!

This inquiry did not include an operative note or denial information. Without this, KZA will provide some general coding guidance.

If the diagnosis is not disc-related, codes 63042 & 63044 would not be appropriate to report with codes 22633 or 22612. Additionally, CPT code 22633 includes discectomy; it would not be appropriate to report 63042. These could be the source of the denials received.

Key Takeaways:

• Laminectomy coding is diagnosis-driven. Generally, reviewing the pre-/postoperative diagnoses and indications will provide this detail; if not, querying the surgeon is advised for clarification.

• There are only reexploration codes for disc (6304x). If the diagnosis is not disc, Modifier 22 could be potentially considered if the documentation reflects and supports additional procedural services.

• Lumbar interbody fusion codes (22630-22634) – include discectomy (63030/63035 & 63042/63044).

• Lumbar interbody fusion codes (22630-22634) have add-on codes (63052/63053) to reflect additional decompression beyond laminectomy/discectomy sufficient to prepare the interspace.

*This response is based on the best information available as of 8/28/25.

63081 or Something Else?

Question:

I received feedback from an external review and am now confused. A partial cervical corpectomy (30%) was documented and reported with CPT 63081, along with fusion and instrumentation. I’ve been informed that this is not a corpectomy. I'm looking for confirmation that this is correct feedback.

Answer:

Thank you for asking KZA!

CPT defines the minimum amount of bone removed for partial corpectomies—the minimum amount for the cervical spine is at least one-half (50%).

The feedback received is correct, as the documented 30% does not support reporting a partial corpectomy. Instead, this is appropriately reported as an ACDF, CPT 22551.

*This response is based on the best information available as of 8/14/25.

63266 & 63267 - Reported Together?

Question:

If the provider removed an epidural abscess from T4-T9 via one incision and then did a separate incision at L4-5, can I bill CPT 63266 and 63267?

Answer:

Thank you for asking KZA!

Remember, the laminectomy for non-neoplasm code set (6326x and 6327x) are regional codes, meaning they include any number of contiguous laminectomies.

The key in the scenario is that these laminectomies were performed via two separate incisions; additionally, they are non-contiguous (T4-T9 and L4/L5). Yes, both codes (63266 & 63267) may be reported as described by the scenario in this inquiry.

*This response is based on the best information available as of 7/31/25.