# Revision Laminectomy ..What do you think?



## kibbit99 (Sep 18, 2009)

Hello everyone.  One of our physicians crossed off the redo laminectomy codes and put 63047 and 63048-22 modifier due to a revision. This confused me.  I thought it would be a redo and he is very familiar with the redo codes.  

May I have your opinions please on the laminectomy portion?

Procedure:  Revision L2-L5 laminectomy and foraminotomy on the left side
Posterior spinal fusion, L2-L5
Revision, left foramintomies L2-L5

Incision was made along the old incision and the spinous process of L1 and L2 were exposed down the L5.  The left hand side lamina was exposed from L2 down to L5.  Great care was taken to make sure that there was no dural rent.  First the lamina at L2 and then lamina at L5 were completely taken down to the facet.  Next, dissection was carried out laterally.  The facets of L2-3, L3-4, and L4-5 were identified.  Next, a rougeur was used to take off the soft tissue more medial to this.  A trocar was used to scrape the medial aspect of the old laminectomy site.  There was a very small laminectomy that had been performed, that was done almost all away to midline.  At this time, a bur was used to thin the lamina from L2 down to L5 and a curved curette was used to elevate some of the bone.  Next, a Kerrison was carefully used to remove the lamina from L2, L3, and L4 down to L5.  A portion of L5 was also taken down.  Nest the facet joints were very hypertrophied as well since there was significant amount of foraminal stenosis.  I did decide to burr out the facets.  There was significant stenosis at that level in teh foramen and teh foraminotmies from L2 down to L5 were performed and great care was taken into the dura.


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## RebeccaWoodward* (Sep 18, 2009)

CPT code 63040 and  63042 are the only codes which may be reported for procedures performed on a recurrent herniated nucleus pulposus. (per AMA)  63047 is used to report procedures performed for lateral recess stenosis, for example, caused by either ligamentum flavum hypertrophy or facet arthropathy. Since he mentioned significant stenosis, this may be why he opted for this code.  Also, CPT has stated that 63047 *can* be used for a revision surgery (stenosis)


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