Neurosurgery Coding Alert

63051 will be useful, but experts can't agree on 63050

You can safely report 63051 for traditional "open-door" laminoplasty in 2005, but the AMA still hasn't offered clarification on a second laminoplasty code, 63050.
 
New-for-2005 code 63051 describes cervical laminoplasty with decompression of the spinal cord, for two or more vertebral segments, including "reconstruction of the posterior bony elements (including the application of bridging bone graft and non-segmental fixation devices [e.g., wire, suture, mini-plates], when performed)."

This means that coders and surgeons will no longer have to rely on 22899 (Unlisted procedure, spine) to report open-door laminoplasty.

Code 63050 leaves out reconstruction: But many surgeons and coders are still scratching their heads regarding 63050 (Laminoplasty, cervical, with decompression of the spinal cord, two or more vertebral segments), which CPT also introduced in 2005. This procedure seems to be the same as that described by 63051, only without the reconstruction of the posterior bony elements. In other words, the code opens the "door" but doesn't leave anything to prop the door open.

Experts were hoping the new CPT guidebook would clarify the reason for 63050's existence. But the confusion remains, says Eric Sandhusen, CPC, CHC, director of compliance at Columbia University department of surgery. "Laminoplasty done without the reconstruction is very rare," he says.

Some surgeons are performing laminoplasty in this way, however, says Steve Hysell, MD, a neurosurgeon at Central California Faculty Medical Group in Fresno, Calif. The surgeon sutures the spine open instead of inserting a piece of bone. But Hysell thinks this technique may become obsolete, explaining that in these cases, the spine could close up on its own or cause the patient pain.

New Decompression Technique Calls for 22899

Meanwhile, another emerging spinal surgery technique still lacks a CPT code, Hysell says, meaning that you'll have to rely on unlisted-procedure code 22899.

During this new method for spinal nerve decompression, the surgeon drills both sides of the spine and creates a groove on both sides of the lamina, then passes a wire saw underneath the lamina. The surgeon then splits the lamina down the midline at its peak and inserts a bone graft to keep it open.
 
This is a risky procedure because sliding anything under the lamina can risk damage to the spinal cord, Hysell says. The advantage, however, is that the surgeon can tilt the apex of the lamina to change the anatomy of the spine, if necessary.

Payer tip: Remember, anytime you report an unlisted-procedure code, such as 22899, you must provide the payer with full documentation to describe the procedure. In addition, you should compare the unlisted procedure to the most similar procedure for which there is a dedicated CPT code. This comparison will help the payer make a better-educated payment decision for the unlisted-procedure code in your particular circumstance.