Neurology & Pain Management Coding Alert

Question: What is the best CPT® code for minimally invasive lumbar decompression (MILD)?

Colorado Subscriber

Answer: CPT® does not include a code specifically for MILD, so you'll choose between two 'unlisted' codes: 22899 (Unlisted procedure, spine) or 64999 (Unlisted procedure, nervous system).

Coders sometimes ask if 63030 (Laminotomy [hemilaminectomy], with decompression of nerve root[s], including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disc, including open and endoscopically-assisted approaches; 1 interspace, lumbar) can be used for MILD. The answer is no because of the difference in what MILD represents and the descriptor for 63030. The MILD procedure is a fluoroscopically guided needle-based approach without direct visualization of the neural structures and is not intended for removal of disc material. Code 63030, by contrast, represents an open surgical or open with endoscopic-assisted approach.

Looking ahead: A new Category III code that could apply to the MILD procedure will go into effect July 1, 2011 and will be listed in CPT® 2012. The new choice will be 0275T (Percutaneous laminotomy/laminectomy [intralaminar approach] for decompression of neural elements, [with or without ligamentous resection, discectomy, facetectomy and/or foraminotomy] any method under indirect image guidance [e.g., fluoroscopic, CT], with or without the use of an endoscope, single or multiple levels, unilateral or bilateral; lumbar). Remember, CPT® Category III guidelines state, "If a Category III code is available, this code must be reported instead of a Category I unlisted code."