January 17, 2019

Question:
Hello Kim!  Could please help me verify the best code to use?  This op note states it is a re-do discectomy but this is the first time my neurosurgeon has done a procedure on this patient. My question is…since my doctor did not do the first procedure, would I bill this as a 63030 or should it be 63042? The nurse stated the neurosurgeon did not do the prior procedure and it is past the 90-day global. Please advise. Thank you for your help.

Answer:
Hi – good to hear from you!  The re-exploration can be performed and billed by any surgeon.  The point is that the patient is having a re-exploration (not that the same surgeon is doing it).  CPT 63042 is valued higher than 63030 to account for the scar tissue / adhesions / altered anatomy that occurs after the first procedure at the same level.  The scar tissue / adhesions / altered anatomy is going to make the procedure more difficult regardless if the same surgeon did the first procedure.  So this is 63042, not 63030, because you are out of the 90-day global period of the original procedure.

*This response is based on the best information available as of 1/17/19.