Neurosurgery Coding Alert

Question: I have two similar cases that I need help coding:

Wisconsin Subscriber

Answer: Global services for the osteotomy procedure (22214, Osteotomy of spine, posterior or posterolateal approach, 1 vertebral segment; lumbar) include the decompression, so you would not 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) or 63048 (...each additional segment, cervical, thoracic, or lumbar [list separately in addition to code for primary procedure]) with 22214.

In the first example, the osteotomy and decompression are reported at the same segmental level. Therefore, you would need to choose either 63047 or 22214, provided that the documentation supports decompression above that required to perform an interbody fusion (since the code 22630 includes laminectomy and facetectomy).

In the second example, an additional segmental level of decompression is performed. At the L4-L5 level, the rules described above apply. For the decompression at L5-S1, where neither an interbody fusion nor osteotomy are performed, you may separately report a decompression with 63047-59 (assuming that the physician performs a laminectomy with at least partial factectomy.)