# Laminectomy - Segment vs. Interspace



## broncsrox (Oct 14, 2011)

I am being trained on spine surgery coding and I'm not sure I agree with what my trainer is telling me about a certain code. 

Patient had L3-4, L4-5, L5-S1 laminectomy with L3, L4, L5, S1 bilateral foraminotomies and decompression of neural elements. Diagnosis is stenosis with bilateral radiculopathy.

Which is the correct way to bill this out.....

1. 63047 + 63048 x2
or...
2. 63047 + 63048 x3

Would appreciate as many responses as possible so that I have a wide variety of reasoning.

Thanks much!


----------



## penguins11 (Oct 14, 2011)

I was always taught that you bill per nerve root decompressed.  If the dr does not specify which nerve root was decompressed you bill per interspace, if they specify nerve root you bill per segment.


----------



## broncsrox (Oct 14, 2011)

Thank you for your response. The body of the op note does not specifically say "nerve root". Here's an exerpt for you to consider...
"After doing the central decompression, lateral recess decompression and foraminotomies at the L3, L4, L5 and S1 levels we probed each of the foramen to make sure they were widely patent, which they were". 

Does that equate to 4 nerve roots?


----------



## hewitt (Oct 14, 2011)

Seems the key is figuring out how many "single vertebral segments" there are.... This link is interactive, showing the anatomy of the spine. http://www.spine-health.com/video/spine-anatomy-interactive-video You can compare this to http://en.wikipedia.org/wiki/Spinal_cord and look under the section titled "Spinal Cord Segments." Hope this helps!


----------



## penguins11 (Oct 17, 2011)

I would probably equate this to 4 segments.  We were always told per foraminotomy or per nerve root decompressed.  I would probably ask the surgeon to clarify this in future OR's.


----------

