Neurosurgery Coding Alert

Question: How does cervical laminoplasty differ from laminectomy? What should I look for in the documentation to distinguish these procedures?

Mississippi Subscriber

Answer: The typical laminectomy involves complete removal, at one or more levels, of the entire lamina from both sides of the spinous process. Open-door laminoplasty, in contrast, decompresses the spinal cord while retaining structural support for the vertebral column, as described by the AMA's CPT Changes 2005: An Insider's View (pages 112-113).

In a nutshell: To differentiate cervical laminoplasty from cervical laminectomy, look for language in the operative note that the surgeon decompresses the spinal cord while keeping the vertebral column's support system intact.
To report laminoplasty, you should select one of two codes:

- 63050 -- Laminoplasty, cervical, with decompression of the spinal cord, two or more vertebral segments

- 63051 -- ... with reconstruction of the posterior bony elements (including the application of bridging bone graft and non-segmental fixation devices (e.g., wire, suture, mini-plates), when performed

Of these two codes, 63051 describes the more common procedure, which involves reconstruction of the posterior spinal elements. The surgeon places bone grafts in the space left by the "open door" (thus "propping the door open") and secures the bone graft with titanium plates or other instrumentation to provide structural stability and to prevent the "door" from closing.

The procedure described by 63050 is similar to 63051, only without the reconstruction of the posterior bony elements. The surgeon simply sutures the spine open instead of inserting a piece of bone. Surgeons rarely perform this procedure because the spine could close on its own during healing and cause further problems for the patient.

When reporting cervical laminoplasty, remember that you should not code additionally for arthrodesis (22600 and +22614), spinal instrumentation (22840-22842), laminectomy (63001, 63015, 63045, and +63048) or reconstruction of dorsal spinal elements (+63295) at the same vertebral levels where the laminoplasty procedure takes place, according to CPT instructions. To the extent that the surgeon performs any of these procedures at the same vertebral level(s) as the laminoplasty, they are included in the laminoplasty procedure itself.

-- Technical and coding guidance for You Be the Coder and Reader Questions provided by Gregory Przybylski, MD, director of neurosurgery at the New Jersey Neuroscience Institute, JFK Medical Center in Edison.