You can report laminectomy and laminotomy together, if required If the surgeon extends a bilateral or unilateral cervical laminectomy significantly above or below the targeted segment to remove part of an adjacent segment and performs a diskectomy, you may report both the laminectomy and the laminotomy. However, you will have to append modifier -59 (Distinct procedural service) to indicate that the laminotomy was a separate, required procedure. Modifier -22 Provides Another Option As an alternative, you may append modifier -22 (Unusual procedural services) to the appropriate laminectomy code to identify the procedure as more extensive than usual and forgo reporting the laminotomy.
"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," according to the AMA's CPT Assistant (February 2001).
Example: The surgeon removes the left lamina of segment C5, the left and right lamina of segment C6, and the right lamina of segment C7. In addition, he removes a significant portion of the lower left lamina of segment C4 to ease access for a diskectomy at C4/C5. To report the service, assign 63045 (for the unilateral laminectomy at C4), 63048 x 2 (for the bilateral laminectomy at C6 and unilateral laminectomy at C7), and 63030-51-59 (for the laminotomy with diskectomy at C4/C5).
In this case, coding for the above example is 63045-22, 63048 x 2. Be sure to include supporting documentation to justify the claim, along with a request for additional reimbursement commensurate with the increased effort.