Neurosurgery Coding Alert

Question: What is -open-door laminoplasty,- and how should I code for it?


Texas Subscriber

Answer: -Open-door laminoplasty,- or cervical laminoplasty, describes a technique in which the surgeon decompresses the spinal cord while retaining structural support for the vertebral column.

The surgeon cuts through the lamina on one side of the spinous process at the affected level(s) and notches the lamina on the opposite sides to create a -hinge- on which to open the posterior segment of the vertebrae and release the spinal cord. The surgeon may then place bone grafts in the space left by the -open door,- which are secured with titanium plates, to provide structural stability and a place for muscles to reattach. Some surgeons are also now performing -French-door laminoplasties- by cutting through the center of the spinous process and creating -hinges- on both sides of the lamina.

CPT introduced two new codes in 2005 to describe cervical laminoplasty:

- 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).

Codes 63050 and 63051 describe laminoplasty on two or more spinal levels. Therefore, you would report laminoplasty of two levels or of five levels using a single code. If the surgeon performs the laminoplasty on a single level, you should append modifier 52 (Reduced services) to either 63050 or 63051, as appropriate.

Note also that 63050 and 63051 include arthrodesis, instrumentation, laminectomy and/or laminotomy, and spinal reconstruction as described by 22600, 22614, 22840-22842, 63001, 63015, 63045, 63048 and 63295. Therefore, you should not report any of these procedures separately with 63050 or 63051. In addition, 63051 includes bone graft placement to -prop open the door- and application of instrumentation to fix and stabilize the spine.

--Clinical and coding expertise for You Be the Coder and Reader Questions provided by Eric Sandhusen, CHC, CPC, director of compliance for the Columbia University department of surgery.