Gain Reimbursement for Open-door Laminoplasties by Using Unlisted Code
Published on Sat Jul 01, 2000
Open-door laminoplasties are not new, but neurosurgeons are finding new applications for these procedures. The unique nature of this surgery, as well as the lack of a specific CPT code to describe it, requires that such a service be identified by coding it with an unlisted procedure code (64999), using a modifier based on multiple procedure levels (-51), and giving special instructions and documentation to insurance carriers for consideration in the billing process.
Generally, spinal stenosis (723.0 for cervical or 724.00-724.09 for other than cervical) narrowing of the spinal canal can result in spinal cord compression, causing symptoms of pain, numbness, stiffness and loss of motor function. The standard of care for stenosis is a decompressive laminectomy (63001-63017), in which the posterior parts of the spinal canal are removed, allowing blood to flow freely to the nerves and cord, thereby restoring function. The loss of structural stability previously provided by the laminae and spinous processes, however, often results in other spinal problems, such as buckling of the spinous segments known as swan-neck deformity.
When and How to Do a Laminoplasty
According to Alfred C. Higgins, MD, a neurosurgeon with the Wenatchee Valley Clinic in Wenatchee, Wash., the open-door laminoplasty has shown to reduce these complications because it does not completely remove the lamina. Instead, they are reconstructed in a way that creates more space in the spinal canal, while maintaining structural support. This adaptation has been used widely overseas, particularly in Japan, and is now becoming more common in the United States.
The typical laminectomy (63001-63017) involves complete removal, at one or more levels, of the entire lamina from both sides of the spinous process (i.e., the palpable bumps of the backbone). By comparison, an open-door laminoplasty involves drilling through the lamina on one side and approximately 95 percent through on the other side. On lifting the open side, the remaining 5 percent of bone is fractured and then forms the hinge of the door. A small piece of bone allograft is inserted into notches carved in the open side, as if to prop the door open. Finally, the bone graft is secured in place with a titanium mini-plate. This procedure allows the larger spinal canal to take pressure off of the cord.
The retention of the posterior elements is the key benefit of the open-door technique, says Higgins. Especially in an older patient, the loss of the posterior bone structures that occur in a standard laminectomy reduces stability two ways: there is less bone to support the spine, and without the lamina to reattach the muscles to, there is less muscular support. When performed on the lumbar (lower) spine, it can preclude the need for very destabilizing facetectomies (the articulating joint of the spine) [...]
