Neurosurgery Coding Alert

Question: How should I code for an L4-S1 laminectomy for drainage of epidural abscess and drainage and debridement of the L5-S1 interspace? Additionally, the surgeon performed an L3-L4 laminectomy for spinal stenosis.

Delaware Subscriber

Answer: Based on the procedure descriptions alone, you would be coding the first portion of the procedure based on the assumption that the main objective of the L4-S1 laminectomies was to treat the epidural abscess.

For the epidural abscess laminectomies, you will apply code 63267 (Laminectomy for excision or evacuation of intraspinal lesion other than neoplasm, extradural; lumbar). This code encompasses both the L4-L5 and L5-S1 spinal interspaces. Additionally, this code includes drainage and debridement of the L5-S1 interspace. "As with all the decompression laminectomy codes, discectomy, or in this case disc debridement, is considered incidental and inclusive of the laminectomy itself," explains Gregory Przybylski, MD, interim chairman of neurosurgery and neurology at the New Jersey Neuroscience Institute, JFK Medical Center in Edison.

Next, you may feel inclined to apply code 63047 (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; lumbar) for the laminectomy procedure at L3-L4. If you perform a Correct Coding Initiative (CCI) check between these two codes, you will see that 63047 (column 2 code) is bundled into 63267 without the use of an overriding modifier. However, since CPT^® 63267 is a regional lumbar laminectomy code that includes one or more lumbar lamina, the additional removal of the L3 lamina would not be separately reportable, even if performed for the separate diagnosis of lumbar stenosis.

The coding for this claim should be as follows:

• 63267, G06.1 (Intraspinal abscess and granuloma).