Neurosurgery Coding Alert

Question: Codes 63045-63047 refer to vertebral segments. Do they identify a single vertebra, such as third lumbar (L3) vertebra, or do they refer to the motion segment, i.e., the interface of two vertebrae at the facets such as L3/4?

Susan Cole
Cape Girardeau, Mo.

Answer: Laurie Castillo, MA CPC, president of Physician Coding and Compliance Consulting, a physician consulting firm in Manassas, Va., and a coding expert in neurosurgery, says that according to the definition found on page 74 of the CPT 2001, A vertebral segment describes the basic constituent part into which the spine may be divided. It represents a single complete vertebral bone with its associated articular processes and laminae. A vertebral interspace is the non-bony compartment between two adjacent vertebral bodies, which contains the intervertebral disk, and includes the nucleus pulposus, annulus fibrosus, and two cartilagenous endplates. To report a laminectomy of two lumbar segments (L3 and L4), use 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) and 63048 (... each additional segment, cervical, thoracic, or lumbar [list separately in addition to code for primary procedure]). To report a hemilaminectomy of one lumbar interspace (L3-L4), use 63030 (laminotomy [hemilaminectomy], with decompression of nerve root[s], including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disk; one interspace, lumbar [including open or endoscopically assisted approach]). Append modifier -50 (bilateral procedure) to 63030 if the procedure is performed bilaterally.