# Segment vs Interspace



## Orpheus22

Would a Laminectomy on L4 - L5 be considered 1 segment, or 1 interspace? Thanks for any help.


----------



## lorebe22

For a laminectomy, you would count per interspace as they are removing the lamina in between each segment.   In this case, L4-L5 would count as one interspace.

And (yes Frosty) the CPT code description tells us whether we count segments or interspaces.   For example 63045-63047, states "segment" therefore L4-L5 would be two segments = 63047, 63048.


----------



## Frosty

I've recently started coding for a spine surgeon and am confused about this.  If he does a laminectomy at L4 and L5 for spinal stenosis & the code is 63047, it states "single vertebral segment" and the add-on code 63048 states "each additional segment", so why can't we bill both codes.  I don't think laminectomy is talking about the interspace in this case, is it?  I understand that if he's doing a laminotomy at L4-5 for, say, herniated disc, then we would have to use 63030, as it states interspace.  Help!


----------



## jmkitchen

Something to keep in mind;

L4 - L5:  - (dash) = interspace
L4, L5:  , (comma) = segment/level


----------



## CHARLENA79

*63047,63048*

CPT descriptor states per segment not interspace, I interpret this as L4,L5, etc. Meaning if Laminectomy for stenosis was performed L4-L5 this would be two segments 63047,63048. However, I have been having a hard time getting these paid. 
Seems to be disputable across the board. Would be great to get a definite correct answer...if anybody else would like to contribute. ty


----------



## Frosty

I have been billing the 63047 & 63048 per segment as the code states.  I'd like a definitive answer, too, but according to the code, it's per segment.

Also, Lorsho seems to have contradicted him/herself when stating, "For a laminectomy, you would count per interspace as they are removing the lamina in between each segment. In this case, L4-L5 would count as one interspace.

And (yes Frosty) the CPT code description tells us whether we count segments or interspaces. For example 63045-63047, states "segment" therefore L4-L5 would be two segments = 63047, 63048."

First you stated "per interspace", then "segment".  Just wanted to clear that up - unless I completely misunderstood you.  Thanks everyone for your input.


----------



## penguins11

I have always been told at different coding seminars to bill per nerve root decompressed, per forminotomy.  So if this is documented bill per segment, not documented per interspace.


----------



## Frosty

Thanks!  That makes sense.


----------



## RebeccaWoodward*

penguins11 said:


> I have always been told at different coding seminars to bill per nerve root decompressed, per forminotomy.  So if this is documented bill per segment, not documented per interspace.



I agree.  I was taught the same...

For example, if just the L5 roots are seen with an L4/L5 lami, code 63047 “Laminectomy, facetectomy and foraminotomy (unilateral or bilateral with decompression of spinal cord, cauda equina and/or nerve root(s), (eg, spinal or lateral recess stenosis)), single vertebral segment; lumbar” would be reported.* If both the L4 and L5 root pairs are seen in this procedure, codes 63047 and 63048 would be used. The documentation must support the root levels being decompressed.* 

http://www2.aaos.org/aaos/archives/bulletin/aug04/code.htm


----------



## cpccpma

I agree also-laminectomy is how you approach-for spinal stenosis they decompress nerve roots. Be sure your spine physician notes which nerve roots they decompress.


----------



## Frosty

Thank you all.


----------



## T-McG

*Cervical Decompression*

Please help me!! I am really trying to understand this.

Cervical decompression and fusion w/ instrumentation @ c3-c4, c4-c5, c5-c6 

Is 22846 appropriate? I am thinking it should be 22845.


----------



## Frosty

22551 for 1st level fusion (C3-C4), 22552 for C4-5 level & 22552 for C5-6 level.  Instrumentation - 22846 (4-7 vertebral SEGMENTS).  The fusion goes by LEVEL, the instrumentation is by SEGMENT.  In this case there are 3 levels, but there are 4 segments (C3, C4, C5, C6) that the instrumentation would be attached to.  Also, if your surgeon uses cages, you would use 22851 for each level.  Also, if the instrumentation (i.e., plate) is an integral part of the cage and not a separate construct, you would only bill the 22851 for each level there's a cage, & you wouldn't bill the instrumentation code.  That's the way I understand it.  If anyone disagrees, let me know, please.


----------



## T-McG

TY!!!! I got it.


----------

