# laminectomy with foraminotomies



## Vanessa123 (May 21, 2010)

Hello fellow coders,

I have an op report for a decompressive laminectomy with foraminotomies. The dr is wanting to code this as 63005 but that code says without foraminotomies and I can't find a code that just includes the foraminotomies. 63047 includes both facetectomy and foraminotomy. I am new to neurosurgery and is in need of some guidance. PLEASE HELP!!!!!

OPERATIVE PROCEDURE:1) L3-4 decompressive laminectomy with foraminotomies. 2) use of intraoperative fluroscopy for less than one hour

The patient was then placed prone on the operating table with all pressure points padded. A midline skin incision was placed on the patient's back and the incision line was prepped and draped in usual sterile fashion. The skin was copiously infused with Marcaine 0.5% with epinephrine. The skin was incised using a #10 scalpel blade, and all soft tissues were dissected with electorcautery. Self-retaining retractors were placed and the lumbodorsal fascia was incised with electrocautery; the spinous processes of L2, L3, and L4 were exposed using subperiosteal dissection out to the facet joings. After using lateral fluoroscopy to tidentify the appropriate level, the deeper self-retaining retractores were placed and the spinous processes of L3 and L4 were removed using a DeLee Horsley bone biter. The rest of the lamina down to the a ligamentum flavum was incised with a #15 blade over a dental tool. The ligamentum lavum was removed in a medial to lateral fashion using various sized Kerrison punches. The operation was complete with the dura was pulsatlile and translucent blue in color. Foraminotomies were made utiltizing Kerrison punches and their adequacy was tested using a Woodson elevator in the lateral recess.

Hemostatsis was achieved and the wound was irrigated with antibiotic infused saline. The wound was then closed in layers as follows: Lumbodorsal fascia was closed with 0-Vicryl interrupted suture, the deep fascia was closed with 2-0 vicryl interrupted suture, the dermis was closed 3-0 vicryl interrupted suture, and the skin was closed with staples.

63005 ????
76000

Thank you,


Vanessa


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## jira85 (May 21, 2010)

I do coding of spinal surgeries only, so I think I can help you.

Our doctor's normally code this as "63047". The CPT book does say "and/or" so it doesn't have to be both. 

I wish I could tell you that it gets easier, but spine has alot of GRAY areas. Get ready for many debates with others regarding the right way to code spine/neuro procedures!


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## RebeccaWoodward* (May 21, 2010)

I would go with 63030 since this includes a partial foraminotomy. The description for 63030 contains and/or. Just a side note...most carriers bundle fluoro with lami's.


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## RebeccaWoodward* (May 21, 2010)

jira85 said:


> I do coding of spinal surgeries only, so I think I can help you.
> 
> Our doctor's normally code this as "63047". The CPT book does say "and/or" so it doesn't have to be both.
> 
> I wish I could tell you that it gets easier, but spine has alot of GRAY areas. Get ready for many debates with others regarding the right way to code spine/neuro procedures!



63047 does require all three...lam, facetectomy *and *foraminotomy.


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## Vanessa123 (May 21, 2010)

Rebecca,

I am uncertain about the 63030 because it says laminotomy (hemilaminectomy) and the doctor is stating he did a laminectomy. What is the difference between the two? Isn't one is a partial removal of the lamina and the other is the full removal of the lamina?

This truly is a hard speciality.

Thank you for responding. It is greatly appreciated.


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## RebeccaWoodward* (May 21, 2010)

Vanessa,

Your are correct.  63030 does involved removing a portion of the lamina from the left or right side whereas a lamin*ectomy* does entail a complete excision of the lamina.  I have heard in the past that some use 63047 with modifier 52 if a laminectomy w/ foraminotomy was performed *without a facetectomy*.  I do agree with you.  I wouldn't report 63005 since he did perform a foraminotomy.  I guess the provider will have to choose the lesser of the two evils...63047-52 with reduced pay or 63030 as is; nothing really stood out to justify modifier 22.

IMHO~


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## DOVERRED (May 21, 2010)

i will say 63047 ..hence key word is decompression


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## RebeccaWoodward* (May 21, 2010)

63047 *requires* all 3 components...This has been stressed by NASS and AANS over the years...



Q: When a procedure is done for lumbar spinal stenosis, such as lumbar laminectomy L2-5, and it is a bilateral procedure, how would you code this operation for Medicare?

A: The operations described by CPT codes 63047 and 63048 are considered to be bilateral procedures. Therefore, neither can be used with a -50 modifier. If the operation includes only a laminectomy of L2, L3, and L4 without any significant foraminotomy or facet joint removal, then the appropriate code would be 63017. If significant foraminotomy *and* facet joint resection is performed at each level, then the coding would be 63047 for the first interspace and 63048 for each additional interspace decompressed


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## RebeccaWoodward* (May 21, 2010)

Also...

Nervous System, 63047 

Question

If a physician performs a diskectomy with a laminectomy, facetectomy, and foraminotomy, *including decompression* of the spinal cord at the L-5 level, but no arthrodesis, how should the diskectomy be reported? 

AMA Comment

Code 63047, Laminectomy, facetectomy and foraminotomy (unilateral or bilateral with decompression of spinal cord, cauda equina and/or nerve roots(s), (eg, spinal or lateral recess stenosis), single vertebral segment; lumbar, should be reported with modifier '-22,' Unusual Procedural services, appended. Modifier '-22' identifies the additional effort involved in performing the diskectomy. 

Her op note does not indicate a facetectomy-


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