I want a second opinion please because our spine surgery office does many transforaminal lumbar interbody fusions BUT they also are doing decompressive laminectomies/reexplorations at the same level . From what I’ve read, Medicare and government insurances will deny the 63047/63042 no matter what reason because they state at the same level, they are just preparing the interspace for the fusion. For commercial carriers, they say you CAN report the 63047 with a modifier if performed for decompression. My spine surgeons document well it’s a decompressive laminectomy and throughout the op report it’s separate as decompression related and I do put a different primary DX on the claim (such as stenosis to reflect this).

My question is…on the Medicare/Medicare Advantage ones, should I be coding the 63047 or 63042 but just put no modifier to leave unbundled and "show the work" or should I just leave them off entirely?

What’s everyone doing for these?

Thank you so much for any assistance and opinions!
Angela