Neurosurgery Coding Alert

Remember: Report +63048 in conjunction with 63045 through 63047.

You learned about laminotomies to stay one step ahead of herniated disc excision errors in your practice in Neurosurgery Coding Alert Vol. 19, No. 6. And, while reporting a laminotomy, you may have also come across a similar sounding term — a laminectomy.

During laminotomies, the neurosurgeon removes the upper and lower portions of adjacent laminae (e.g., at the vertebral interspace). In contrast, in laminectomies, the surgeon removes the entire lamina from a single vertebral segment.

Read on to learn more about laminectomies so you don’t make the crucial mistake of reporting a laminotomy when you should have reported a laminectomy.

Don’t Forget to Report Laminectomy Per Segment

When choosing laminectomy codes, you should report the procedure per spinal segment. CPT^® provides three primary codes and one add-on code to describe laminectomy with decompression:

• 63045 (Laminectomy, facetectomy and foraminotomy (unilateral or bilateral with decompression of spinal cord, cauda equina and/or nerve root[s] [e.g., spinal or lateral recess stenosis]), single vertebral segment; cervical)
• 63046 (... thoracic)
• 63047 (... lumbar)
• +63048 (... each additional segment, cervical, thoracic, or lumbar (List separately in addition to code for primary procedure).

Report 63045, 63046, or 63047 as appropriate for the first spinal level the surgeon treats followed by +63048 for each additional level beyond the first.

CPT^® uses laminectomy as the definition of unilateral (correctly termed hemilaminectomy) or bilateral decompression in the long descriptor of 63045 (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; cervical), adds Gregory Przybylski, MD, past chairman of neurosurgery and neurology at the New Jersey Neuroscience Institute, JFK Medical Center in Edison, New Jersey.

Don’t miss: If you look closely at the code descriptors, you will see that 63045 through +63048 also include “facetectomy and foraminotomy, along with decompression of the spinal cord, cauda equina and/or nerve roots.” A facetectomy is the surgical removal of the articular facets of a vertebra. A foraminotomy is the surgical removal of bone from around the edges of the intervertebral foramina.

Coding example: To provide spinal cord and nerve decompression, the surgeon removes the spinous process and left lamina of the third cervical vertebra (C3), as well as the spinous process and left and right laminae of the fourth cervical vertebra (C4). This would be called a C3-C4 laminectomy. In this case, you should report 63045 for the first spinal level (C3) the surgeon treats followed by +63048 for the subsequent spinal level (C4). Even though the surgeon removes only a single lamina from C3 and both laminae from C4 you report each code “as is” with no modifiers appended. The documentation should include the nerve root(s) decompressed as well as the work of partial or complete facetectomy and, if performed, foraminotomy and discectomy.

Keep Codes 63001 through 63017 in Your Coding Arsenal

If the surgeon performs a laminectomy with exploration and or decompression of the spinal cord and or cauda equina, without facetectomy, foraminotomy, or discectomy, then you would report the following codes for one or two vertebral segments:

• 63001 (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; cervical)
• 63003 (…thoracic)
• 63005 (…lumbar, except for spondylolisthesis)
• 63011 (…sacral).

For more than two vertebral segments, you would report the following:

• 63015 (Laminectomy with exploration and/or decompression of spinal cord and/or cauda equina, without facetectomy, foraminotomy or discectomy (eg, spinal stenosis), more than 2 vertebral segments; cervical)
• 63016 (…thoracic)
• 63017 (…lumbar).

And, for a lumbar laminectomy for spondylolisthesis secondary to spondylolysis, you would report 63012 (Laminectomy with removal of abnormal facets and/or pars inter-articularis with decompression of cauda equina and nerve roots for spondylolisthesis, lumbar (Gill type procedure)).

Remember Importance of Detailed Operative Report for Laminectomies

When billing for laminectomies, make sure to include a detailed operative report that explains the patient’s condition prior to and during surgery, i.e., an appropriate diagnosis(es). Also, be sure to stress that the surgeon removed one or both lamina of the targeted vertebrae.