Neurosurgery Coding Alert

Question: I am coding a patient with severe lumbar spinal stenosis of the L3-L4 and L4-L5 vertebral columns. The surgeon performs a bilateral laminectomy, facetectomy, and foraminotomy of the L3-L4 and L4-L5 spine with an insertion of an interlaminar stabilization device of both columns. How should this be coded? And should I code separately for the stabilization devices?

Oregon Subscriber

Answer: Based on this procedure description, you will apply a code for the decompression procedure in addition to the placement of the stabilization devices.

Laminectomy, facetectomy, and foraminotomy combination procedures are some of the most common spinal decompression procedures for diseases such as spinal stenosis. In this example, you will 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 first lumbar segment and +63048 (... each additional segment, cervical, thoracic, or lumbar [List separately in addition to code for primary procedure]) for the second lumbar segment.

You will follow the same approach for the spinal stabilization devices by applying one base code and an add-on code for the second vertebral segment. For the first lumbar segment, you will apply code 22867 (Insertion of interlaminar/interspinous process stabilization/distraction device, without fusion, including image guidance when performed, with open decompression, lumbar; single level). For the secondlumbar segment, you will apply code +22868 (... second level [List separately in addition to code for primary procedure]).

Caution: Do not confuse spinal stabilization devices following decompression surgeries with biomechanical device insertion codes such as +22853 (Insertion of interbody biomechanical device[s] [eg, synthetic cage, mesh] with integral anterior instrumentation for device anchoring [eg, screws, flanges], when performed, to intervertebral disc space in conjunction with interbody arthrodesis, each interspace [List separately in addition to code for primary procedure]). According to Volume 27: Issue 3 of the CPT^® Assistant, biomechanical devices are "reported when an interbody biomechanical device is placed into a discectomy defect for purposes of a spinal fusion, such as a posterior lumbar interbody fusion (PLIF) procedure or an anterior cervical discectomy and fusion (ACDF) procedure."

Finally, for the diagnosis of lumbar spinal stenosis will apply code M48.061 (Spinal stenosis, lumbar region without neurogenic claudication).