Neurology & Pain Management Coding Alert

Question: Does 63047 require all three components, laminectomy, facetectomy, and foraminotomy, to bill? The surgeon only performed a laminectomy. And should we append modifier 52 if the physician did not perform one of the components?

New York Subscriber

Answer: Yes. You must perform at least parts of all three components (laminectomy, facetectomy, and foraminotomy) to bill 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). Code 63047 involves not only the removal of lamina for central decompression, but also lateral recess decompression in the form of a facetectomy (e.g., medial, partial) and/or foraminotomy at a single lumbar vertebral segment to correct spinal stenosis (narrowing) and to decompress the spinal cord or nerve roots.

You would not append modifier 52 (Reduced services) to 63047. Instead, if the surgeon only performed a laminectomy, then you should look at 63005 (Laminectomy with exploration and/or decompression of spinal cord and/or cauda equina, without facetectomy, foraminotomy or discectomy (eg, spinal stenosis), 1 or 2 vertebral segments; lumbar, except for spondylolisthesis). Code 63005 is generally used for removal of the lamina to provide central decompression of the spinal cord without a more lateral decompression.

• Laminectomy defined:  Excision of the thin bony plate at the back of a vertebra.
• Facetectomy defined: Excision of part/all of the joint in the back that overlies the lateral recess under which the traversing nerve root travels.
• Foraminotomy defined: Incision into the vertebral opening through which nerve bundles exit out of the spinal canal to the abdomen or pelvis (for the lumbar nerve roots).