# 63030 or 63047?



## BFAITHFUL (Oct 19, 2009)

what do you guys think about the following 63030 or 63047 or both?


DX:  Left L4-L5 disc herniation with left L5 radiculopathy

Procedure:  Left L5 hemilaminotomy with foraminotomy and exploration of disc

Operative Procedure:

Under fluoroscopic control, a maidline skin incision was made over length of approximately 1.5cm in the lumbar region at what was called at L4-L5.  The patient had a transitional vertebra and the result that of the level we were addressing was L4-L5 the level of the herniated disc on MRI.  The wound was developed through the subcutaneous tissue, superficial and deep fascia subperiosteally on the left side to the lamina.  fluoroscopy again demonstrated at the level.  Partial laminectomy on the left at L4 was carried out and the ligamentum flavum at L4-L5 elevated and removed exposing the dura beneath.  The L5 nerve root to be seen and a foraminotomy was performed in the root was tight prior to the decompression.  It was draped over underlying tissue.  this was carefully explored and found to be bone.  The nerve root was gently mobilized medially and exploration from medially took place and there was no extruded disc.  There was no protruded disc that could be easily entered, as the floor was quite hard.  For confirmation purposes, fluoroscopy was again obtained and compared to the MRI from preoperatively.  this demonstrated at the correct level and it was seen that there was osteophyte with some disc superficial through it.  Considerable time had been last between the time of the MRI and the surgery.  

We saw that the nerve root on the left, which was symptomatic side, was completely decompressed and no further exploration was indicated.  The hemostasis was meticulously acquired and closure was carried out in the usual mannerwith 10cc of subcutaneous Marcaine.   

thanks


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## magnolia1 (Oct 19, 2009)

Looks like 63030 to me.


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## RebeccaWoodward* (Oct 19, 2009)

I'm throwing this out since I'm curious as to what your opinions would be on this...Per CPT Assistant (Feb 2001)

Nervous System, Surgery, 63030, 63047 (Q&A)

*Question *

My physician performs surgery on the spine that includes laminectomy, decompression of the spine, facetectomy of the *L2* vertebra, and laminotomy with excision of the intervertebral disk at *L1*. Can codes 63030 and 63047 be used to identify the specific procedures performed? 
*AMA Comment* 

If both a laminectomy and a laminotomy are performed on the spine at different levels, then it would be appropriate to report a separate code for each of the procedures performed. In response to your specific question, decompressive laminectomy performed at the L2 level would be reported using 63047, and decompressive laminotomy performed at L1 should be reported using 63030 to identify the specific services performed. Modifier -51, Multiple Procedures, should be appended to the secondary, additional procedure performed. *****************************************************************************
"Partial laminectomy on the left at *L4* was carried out and the ligamentum flavum at L4-L5 elevated and removed exposing the dura beneath."  *63005* since there isn't mention of a facetectomy, foraminotomy, discectomy?


"The *L5 *nerve root to be seen and a foraminotomy was performed in the root was tight prior to the decompression. It was draped over underlying tissue. this was carefully explored and found to be bone. The nerve root was gently mobilized medially and exploration from medially took place and there was no extruded disc. There was no protruded disc that could be easily entered, as the floor was quite hard. For confirmation purposes, fluoroscopy was again obtained and compared to the MRI from preoperatively. this demonstrated at the correct level and it was seen that there was osteophyte with some disc superficial through it. Considerable time had been last between the time of the MRI and the surgery. We saw that the nerve root on the left, which was symptomatic side, was completely decompressed and no further exploration was indicated." *63030?*

Thoughts?


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## BFAITHFUL (Oct 20, 2009)

Rebecca, why would you prefer going with 63030 & not 63047, thank you!


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## RebeccaWoodward* (Oct 20, 2009)

The primary purpose of 63047 is to relieve spinal stenosis.  It appears, to me ,that the primary purpose for this particular scenario is to treat a herniated disc (63030).


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## BFAITHFUL (Oct 20, 2009)

You know that was my way of thinking too, but I recently read an article in one of Margie Scalley Vaught book (FAQ for orthopedics) where this is not always the case, When I get home, I will post it.


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## RebeccaWoodward* (Oct 20, 2009)

Let me know...I'm using the 2-1-2008 Orthopedic Pink Sheet as my main reference.


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## BFAITHFUL (Oct 22, 2009)

Sorry, I totally forgot about this, I will post this article this evening


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