# 63030 vs 63047 - hemilaminectomy



## kibbit99

Dr. has L5-L4 hemilaminectomy, foraminectomy on the right side.  I am saying 63030, but he is saying 63047 because of the foraminectomy.  This cannot be correct?

CPT guidelines indicate foraminotomy.  Would the "ectomy" change anything?  What are the key words you advise the physician to differentiate 63030 vs 63047.  Also, here is the op on above scenario:  Thanks!

DX:  Forminal spinal stenosis

PROCEDURE:  L5-L4 hemilaminectomy, foraminectomy on the right side.

PROCEDURE IN DETAIL:  An incision was made on back at appropriate level.  Knife dissection was taken down through the sub tissue where the fascia lie.  The fascia on the right side of the spine was stripped. The deep Taylor retractor was placed.  An intra-operative x-ray confirmed fluro at the proximal L5 pedicle and then dissected up, and as able to trace out the foramen at L4-L5.  There appeared to be some compression at this lamina into the next foramen, there was significant stenosis as well as adherent tissue that was adhered and stuck to the dura.  I was able to dissect this down to the S1 pedicle and traced out the root above or below.  There was significant more compression at this level, which was removed.  Once that was done, I was able to trace all nerve roots out.  The wound was then copiously irrigated with pulsatile saline lavage.  The deep fascia was closed with 0 Vicryl, sub tissue with 2-0 Vicryl, running Prolene for skin.


----------



## RebeccaWoodward*

I do agree with 63047.  This is a Q/A that you may find helpful.

*Question*: The spine surgeon performs a Left L5 hemilaminectomy and left L5 decompressive foraminotomy for spinal stenosis. Do you report 63030 or 63047? If 63047, please explain why, when from what I can tell, a full laminectomy is not being performed.  What is the difference between 63030 and 63047 other than how much of the lamina is being removed?

I recently got clarification on this issue from CPT, and wanted to share this information with you, because it represents a departure from the thinking I previously had on laminectomy and laminotomy coding. 

Previously, I would have told you that the difference between a laminectomy (63047) and a laminotomy (63030, also sometimes called a hemilaminectomy) is in the amount of bone removed. 

However, CPT has clarified that there are additional factors the coder must consider when selecting 63030 vs. 63047. Let's start by looking at the full descriptors for the codes: 

-63030 Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disk; one interspace, lumbar (including open or endoscopically-assisted approach)
-63047 Laminectomy, facetectomy and foraminotomy (unilateral or bilateral with decompression of spinal cord, cauda equina and/or nerve root(s) [e.g. spinal or lateral recess stenosis]), single vertebral segment, lumbar
As you can see, both codes include facetectomy and foraminotomy, however there are some key differences between the codes, CPT explained. 

The big difference is the purpose of the procedure: You should report 63030 when laminotomy is performed with a diskectomy, to treat spinal disc herniation using either an open procedure or under endoscopic assistance, CPT says. 

The code was revised starting in 2000 to this use, as explained in the November 1999 CPT Assistant:

"Code 63030 has been revised to clarify the appropriate reporting of this code for use when performing laminotomy for diskectomy using endoscopic assistance."

In addition, 63030 is a unilateral code, and should be reported for the first occurrence of disc herniation,   CPT explains.

By contrast, Code 63047 is used to report procedures performed for lateral recess stenosis, for example, caused by either ligamentum flavum hypertrophy or facet arthropathy. 

CPT explains that laminectomy is a surgical procedure for treating spinal stenosis by relieving pressure on the spinal cord. The surgeon removes or trims the lamina to widen the spinal canal and create more space for the spinal cord and spinal nerves.

It would be appropriate to report 63047 for the procedure, even though it describes a partial laminectomy only of the left lamina and foramen. The purpose of the procedure is to relieve spinal stenosis, which is the primary use of 63047.


----------



## martnel

I was also going to say to look at the diagnosis.  Good explanaton Rebecca!


----------



## kibbit99

I always used the dx as the answer prior and then someone told me a hemi is a hemi regardless of dx and that threw me off.  I wonder if they will revise the meaning next year?

Thanks everyone!


----------



## martnel

Well, I guess Dx should not be the ONLY measure.... but sometimes it helps with these spinal surgeries.


----------



## seslinger

What if the diagnosis is herniation disk & spinal stenosis of L5-S1 and dr. did hemilaminectomy, foraminotomy and diskectomy?

I am thinking 63047 but then I wasnt sure if you can bill 63030 with it, very confusing.

Sheila, CPC


----------



## Cbyrnes

RebeccaWoodward* said:


> I do agree with 63047.  This is a Q/A that you may find helpful.
> 
> *Question*: The spine surgeon performs a Left L5 hemilaminectomy and left L5 decompressive foraminotomy for spinal stenosis. Do you report 63030 or 63047? If 63047, please explain why, when from what I can tell, a full laminectomy is not being performed.  What is the difference between 63030 and 63047 other than how much of the lamina is being removed?
> 
> I recently got clarification on this issue from CPT, and wanted to share this information with you, because it represents a departure from the thinking I previously had on laminectomy and laminotomy coding.
> 
> Previously, I would have told you that the difference between a laminectomy (63047) and a laminotomy (63030, also sometimes called a hemilaminectomy) is in the amount of bone removed.
> 
> However, CPT has clarified that there are additional factors the coder must consider when selecting 63030 vs. 63047. Let's start by looking at the full descriptors for the codes:
> 
> -63030 Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disk; one interspace, lumbar (including open or endoscopically-assisted approach)
> -63047 Laminectomy, facetectomy and foraminotomy (unilateral or bilateral with decompression of spinal cord, cauda equina and/or nerve root(s) [e.g. spinal or lateral recess stenosis]), single vertebral segment, lumbar
> As you can see, both codes include facetectomy and foraminotomy, however there are some key differences between the codes, CPT explained.
> 
> The big difference is the purpose of the procedure: You should report 63030 when laminotomy is performed with a diskectomy, to treat spinal disc herniation using either an open procedure or under endoscopic assistance, CPT says.
> 
> The code was revised starting in 2000 to this use, as explained in the November 1999 CPT Assistant:
> 
> "Code 63030 has been revised to clarify the appropriate reporting of this code for use when performing laminotomy for diskectomy using endoscopic assistance."
> 
> In addition, 63030 is a unilateral code, and should be reported for the first occurrence of disc herniation,   CPT explains.
> 
> By contrast, Code 63047 is used to report procedures performed for lateral recess stenosis, for example, caused by either ligamentum flavum hypertrophy or facet arthropathy.
> 
> CPT explains that laminectomy is a surgical procedure for treating spinal stenosis by relieving pressure on the spinal cord. The surgeon removes or trims the lamina to widen the spinal canal and create more space for the spinal cord and spinal nerves.
> 
> It would be appropriate to report 63047 for the procedure, even though it describes a partial laminectomy only of the left lamina and foramen. The purpose of the procedure is to relieve spinal stenosis, which is the primary use of 63047.



I am attempting to appeal a surgery code with this very issue.  Is there a link you can provide so I can provide documentation?  Thanks for any help.

Christine Byrnes  M.H.A.
Florida Spine Care Center


----------



## RebeccaWoodward*

This is an "oldie goldie" post... It took me a few minutes but I think I've located it.  I'll have to fax this to you, though.


----------



## seslinger

Rebecca my fax is 440-205-5402

thanks Sheila


----------



## lodawnyoung

My doctors give me a dx of stenosis and herniated disc all the time. I am wondering if I can bill a 63047 with a 63075? I don't have any CCI edits pop up when I code those together. Does anyone know if a discectomy is included in the 63047? 63047 deals with the segment not the interspace so I would think that it does not, but I can't find an answer.


----------

