Neurosurgery Coding Alert

Some of these laminectomies are separately reportable

When you-re scouring your surgeon's posterior lumbar interbody fusion (PLIF) notes for all the services that you can rightfully report, you have a lot to look for.
 
First, you need to check how many interspaces the surgeon worked on. Then, you should choose a bone graft code and a code for pedicle screw fixation, if the surgeon performed one.
 
And that's not all: The final step to filing a solid PLIF claim involves checking for a separately reportable laminectomy. Because a standard laminectomy is a necessary component to the PLIF procedure, payers typically bundle the service into the PLIF codes.
 
There are also instances, however, when you may report the laminectomy and the PLIF codes for the same encounter, coders say.
 
-If the surgeon is removing the disc for the sole purpose of prepping the vertebrae/endplates for PLIF, then the removal of the disc (that is, laminectomy) is bundled,- says Susan Allen, CPC, CCS-P, coding manager and compliance officer for Florida Spine Institute in Clearwater, Fla.
 
But if the surgeon is decompressing the spinal cord and/or nerve roots beyond that required to perform the PLIF, you can report a separate laminectomy code (63047-63048). To report a separate laminectomy, the surgeon must expend more time and expertise than he would during the standard PLIF laminectomy.

CPT Allows Coding -Excess Work- Laminectomy

Check out this explanation from the January 2001 CPT Assistant: Report 63047-63048 -when in addition to removing the disc and preparing the vertebral endplate, the surgeon removes posterior osteophytes and decompresses the spinal cord or nerve root(s), which requires work in excess of that normally performed when doing a PLIF.-
 
Example: A patient with a degenerating lumbar disc reports to the neurosurgeon for a PLIF. The surgeon performs PLIF at L2-L3 and L3-L4. During the procedure, she also fixes pedicle screws across one interspace, removes two posterior osteophytes and decompresses the patient's nerve roots at both interspaces.
 
In this scenario, if the surgeon's laminectomy and decompression was necessary for reasons beyond prepping the vertebrae, the laminectomy is separately reportable with the following codes:
 
- 22630 (Arthrodesis, posterior interbody technique, including laminectomy and/or discectomy to prepare interspace [other than for decompression], single interspace; lumbar) for the L2-L3 PLIF

 - +22632 (- each additional interspace [list separately in addition to code for primary procedure]) for the L3-L4 PLIF

 - 63047 (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; lumbar) for the L2-L3 laminectomy

 - +63048 (- each additional segment, cervical, thoracic or lumbar [list separately in addition to code for primary procedure]) for the L3-L4 laminectomy

 - modifier 59 (Distinct procedural service) attached to 63047 and 63048 to show that the laminectomy service was distinct and separate from the PLIF

 - 22840 (Posterior non-segmental instrumentation [e.g., Harrington rod technique, pedicle fixation across one interspace, atlantoaxial transarticular screw fixation, sublaminar wiring at C1, facet screw fixation]) for the pedicle screw fixation

 - 722.52 (Degeneration of lumbar or lumbosacral intervertebral disc) linked to 22630, 22632, 63047, 63048 and 22840 to describe the patient's condition.