Neurosurgery Coding Alert

Question: May we report arthrodesis (22630) and laminectomy (63047) during the same session? My surgeon wants to report these separately, but I thought every arthrodesis includes laminectomy.


Virginia Subscriber

Answer: The laminectomy required to access and prepare the interspace is a standard component of arthrodesis, and you would not normally report 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) in addition to 22630 (Arthrodesis, posterior interbody technique, including laminectomy and/or discectomy to prepare interspace [other than for decompression], single interspace; lumbar). The AMA has supported this coding with citations in the December 1999 and January 2001 editions of CPT Assistant.

The January 2001 issue goes on to note, however, that you may report 63047 in addition to 22630, -when in addition to removing the disc and preparing the vertebral endplate, the surgeon removes posterior osteophytes and decompresses the spinal cord or nerve root(s), which requires work in excess of that normally performed when doing a posterior lumbar interbody fusion (PLIF).-

Bottom line: If the surgeon performs laminectomy for decompression in addition to arthrodesis, you may report the laminectomy separately.

For example: The surgeon prepares the L1-L2 interspace for arthrodesis, and he extends the laminectomy outward to decompress the nerve root by performing a foraminotomy, and removes excess bone. The physician is not removing the bare minimum of the disc for the fusion, but rather treating the stenotic condition and decompressing the nerve roots.

In this case, you should report 22630 for the arthrodesis and 63047 for the -extended- laminectomy. You may also report any bone graft or instrumentation procedures the surgeon performs at the same time.

Don't forget to append modifier 59 (Distinct procedural service) to 63047. Provide clear documentation to show that the laminectomy and arthrodesis were separate.