# Laminectomy with Onlay Fusion



## Ccgerson (Jun 30, 2017)

I rarely code spinal surgeries, and am not sure if an onlay fusion qualifies for the arthrodesis code 22612.
Without giving the entire OP note, this is the Diagnosis and procedure performed. 
I'm thinking 63047  for L3-4  and 22612 + ??  63407 for fusion. 

Severe spinal stenosis L3 4 L4 5 minimal spondylolisthesis L3 on 4

Operation performed: 
Decompressive laminectomy, bilateral L3 4 and L4 5 with partial facetectomy
Onlay fusion L3 4

Thank you,
Cindy


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## AlanPechacek (Jul 3, 2017)

Yes, an "Onlay Graft" would be a method of effecting a spinal fusion/arthrodesis.  The issues for this case are whether the bone graft used was taken from the patient, i.e. an Autograft, or was Bone Bank bone used, i.e. an Allograft.  This makes a difference as to the code for the bone graft: +20938 for an Autograft, or +20931 for an Allograft, since Onlay Grafts are usually "Structural" grafts of cortical bone segments/pieces.  Also, the fact that he did Bilateral Decompressive Laminectomies at two levels effects your procedure coding as well: 63047 applies to one/first level, and +63048 to each other/additional level.
     Therefore, at L3-4, he did the Laminectomy (63047), plus a Posterior Fusion (22612), and also the Bone Graft (+20938 if an Autograft, or +20931 if an Allograft).  At the L4-5 level, he did the Laminectomy at a second level (+63048).  All of these codes apply to your case.

Hopefully this helps.

Respectfully submitted, Alan Pechacek, M.D.
icd10orthocoder.com


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## Ccgerson (Jul 6, 2017)

*Bone Graft help*

It looks like the autograft wasn't really harvested, but was taken from bone removed during the laminectomy?  I'm thinking 20938 couldn't be used for this, since it's not a separate incision.  Am I correct?  See below

"After adequate decompression the transverse processes were identified at L3 and L4 utilizing a bur some decortication was performed of the dorsal surface and onlay bone graft from the decompression and removal of the spinous processes as well as lamina was then placed in the lateral gutters bilaterally."


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## AlanPechacek (Jul 6, 2017)

You are correct that +20938 would not be correct since he did not harvest his graft from a separate site, nor was it a "structural graft."  He used what is usually termed "Local Bone," i.e. derived/harvested from the operative site, which was bits and pieces from the lamina, spinous processes, etc.  This would fit the descriptor for +20936, which is an Add On code for the graft, and can be added to the fusion code 22612.  It is still considered an "Onlay Graft."

Hope this helps clarify this situation.

Sincerely, Alan Pechacek, M.D.


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## Ccgerson (Jul 7, 2017)

Thank you!  I didn't realize there was a code for graft from same incision.  Somehow I missed that.  Thank you for your timely help.


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