Neurosurgery Coding Alert

Question: What is the appropriate code for open-door laminoplasty? Should I report this as laminectomy (for example, 63001, Laminectomy with exploration and/or decompression of spinal cord and/or cauda equina, without facetectomy, foraminotomy or diskectomy [e.g., spinal stenosis], one or two vertebral segments; cervical) with modifier -22 (Unusual procedural services)?

Pennsylvania Subscriber

Answer: CPT contains no dedicated code to describe open-door laminoplasty. Although this has some similarity to the laminectomy described by codes 63001-63017, the technique and graft placement make it sufficiently unique to report the service using 64999 (Unlisted procedure, nervous system) for the initial vertebral level at which the procedure takes place. Because of the careful and extensive work involved, you should report additional levels beyond the first using the same code with modifier -51 (Multiple procedures) appended. And, if performed, you should report structural allograft separately using 20931 (Allograft for spine surgery only; structural).
 
Although the procedures are associated, an open-door laminoplasty is more complex and time-consuming than a typical laminectomy and includes elements of both excision and fusion. For this reason, and because CPT and many coding experts advise against using the "next best" code when reporting a procedure without a dedicated CPT descriptor, do not report 63001-63017 for open-door laminoplasty.