CPT 49000

I currently provide anterior exposure for spine surgeons doing an anterior lumbar interbody fusion ( ALIF) and have been coding 49000 for an exploratory laparotomy (49010 if the approach is retroperitoneal). Is this correct?

Answer:

Each open surgical procedure is valued to include the approach, the repair and the closure. When providing exposure for a spine surgeon to gain access to the anterior lumbar spine, the vascular or general surgeon is providing the approach (and usually the closure) of the open spine procedure. The spine surgeon performs the repair. Each surgeon is providing a distinct part of a single CPT code (22558), which makes this co surgery per CPT rules. Both surgeons report 22558 with a 62 modifier and each must dictate their own operative note. Reporting an exploratory laparotomy code would be double billing the approach, which is inclusive to the 22558 code.