Neurosurgery Coding Alert

See how turning to 63030, 63047 could trip you up.

Accurately reporting minimally invasive lumbar decompression (MILD) procedures with open and endoscopic techniques just got a little bit easier. When your neurosurgeon performs a MILD, follow this scenario and coding advice offered in the November 2010 CPT Assistant.

Scenario: Through a small incision and using fluoroscopic guidance, the surgeon performs an epidurogram to identify the specific lumbar stenosis location, followed by a small laminotomy and decompressive resection of the ligamentum flavum to treat the patient's central canal spinal stenosis.

Question: Should you report 63030 or 63047 for this procedure?

Answer: No, you would report these services with "unlisted spine code, 22899 or 64999, Unlisted procedure, nervous system," CPT Assistant explains. The rationale is that the "MILD procedure involves a fluoroscopic, needle-based procedure without direct visualization of critical neural structures," CPT Assistant states. MILD procedure devices "are not intended for disc procedures" but should be used for "tissue resection at the perilaminar space within the interlaminar space, and at the ventral aspect of the lamina. These devices are not intended for use near the lateral neural elements and remain dorsal to the dura using image guidance and anatomical landmarks," according to CPT Assistant.

So, you would not apply code 63030, (Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disc, including open and endoscopically-assisted approaches; 1 interspace, lumbar), "as the MILD procedure is a needle-based approach and is not intended for removal of disc material versus an open surgical or open with endoscopic-assisted approach (code 63030)," CPT Assistant clarifies. You would report 63030 "only when an open surgical technique (not an endoscopic approach/technique) is used and the intrinsic essential components of this code are performed; namely, a resection of the vertebral component, spinous processes, and lamina, which must include a discectomy, for decompression of the nerve root(s), as well as any laminotomy or laminectomy foraminotomy along with partial facetectomy, as needed for decompression of the nerves or required as part of the surgical approach".

CPT Assistant further explains that you would not report 63047 (Laminectomy, facetectomy and foraminotomy (unilateral or bilateral with decompression of spinal cord, cauda equina and/or nerve root[s], [eg, spinal or lateral recess stenosis]), single vertebral segment: lumbar) when your surgeon performs a MILD procedure "as code 63047 is only reported if anopen surgical technique (not solely an endoscopic approach/technique) is used and when the intrinsic components of this code's essential elements are performed, namely a resection of the vertebral component, spinous processes which includes a laminotomy, laminectomy or hemilaminectomy (unilateral or bilateral) lamina, along with foraminotomy with partial facetectomy."

Also considered part of 63047 services are repairs of small dural "lacerations or leaks, and harvesting and placement of soft tissue graft, muscle, or fat when obtained from within the primary surgical incision" and would not be reported separately, says CPT Assistant.