CPT® Code 63042

Can CPT® 63042 be billed for reoperation if the procedure is not for a herniated disc? The physician is suggesting that reoperation is more difficult than operating on a petient who has never had spine surgery before, so (according to him), the 63042-59 is the way that the increased difficulty for reoperation is coded. He says that it is a supplement to other codes, not a bill for discectomy.

Any assistance would be greatly appreciated.

Thanks,
D. Salters

re: CPT® Code 63042

No. CPT® 63042 is used only when the patient had a previous discectomy at the same level. If the patient now requires a reoperation for stenosis (eg, re-do laminectomy/foraminotomy) then use 63047. Modifier 22 may be appended if the addtional work of scar tissue excision, etc. is documented.

Kim Pollock, RN, MBA, CPC
KarenZupko & Associates, Inc.
www.karenzupko.com