Neurosurgery Coding Alert

Question: How can we report repair for a herniated disc at the lumbar region? Does 63047 qualify for these services? How can we code for re-do procedure for herniated disc?

New York Subscriber

Answer: When your surgeon does a surgical correction at a lumbar interspace for a herniated lumbar disc, you submit code 63030 (Laminotomy [hemilaminectomy], with decompression of nerve root[s], including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disc; 1 interspace, lumbar). While 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) includes discectomy when performed, if the primary procedure is discectomy. You should report CPT^® 63030 for the primary level. The primary reason to report 63047 is when the condition being treated is spinal stenosis, typically a consequence of facet arthropathy.

Modifier: Code 63030 is a unilateral code. When your surgeon does a bilateral procedure at the same lumbar spine level, you append modifier 50 (Bilateral procedure).

Additional levels: If your surgeon does an additional level, the add-on code is +63035 (Laminotomy [hemilaminectomy], with decompression of nerve root[s], including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disc; each additional interspace, cervical or lumbar [List separately in addition to code for primary procedure]).

You submit code 63047 when your surgeon does a decompression at a single lumbar level for a primary diagnosis of stenosis or spondylosis. In the operative note, you will find details of decompression of neural elements through facetectomy and foraminotomy.

Note: Code 63047 is a unilateral or bilateral code. You do not append modifier 50 to the code for bilateral procedures.

Re-do laminotomy: When your surgeon repeats a hemi-laminotomy for a recurrent lumbar herniated disc at the same spinal level of the initial discectomy after the global period, you submit code 63042 (Laminotomy [hemilaminectomy], with decompression of nerve root[s], including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disc, reexploration, single interspace; lumbar).

Like code 63030, this code (63042) is a unilateral code and can use modifier 50. The add-on revision code is +63044 (Laminotomy [hemilaminectomy], with decompression of nerve root[s], including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disc, reexploration, single interspace; each additional lumbar interspace [List separately in addition to code for primary procedure]).

Revision laminectomy: There is no revision laminectomy code. For re-do lumbar laminectomy for stenosis, you report code 63047. If the work of the laminectomy is enough to merit it, you may append modifier 22 (Increased procedural service).