Neurosurgery Coding Alert

Question: What would be the difference between 63030 versus 63056 far lateral discectomy? Does the code 63056 apply to midline incisions for lumbar disc herniations? What is a far lateral disc herniation? Do midline incisions apply to the far lateral herniations?

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Answer: In lumbar disc herniation procedures, you do not select the code based on incisions. You pick up a code depending upon what interspace target was operated upon for decompression.

To decide between 63030 (Laminotomy [hemilaminectomy], with decompression of nerve root[s], including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disc; 1 interspace, lumbar) and 63056 (Transpedicular approach with decompression of spinal cord, equina and/or nerve root[s] [e.g., herniated intervertebral disc], single segment; lumbar), you need to check what structure(s) were involved in the decompression.

The code 63030 implies a laminotomy for decompression of nerves in the lateral recess or proximal foramen. The code 63056 is applied to decompression of more lateral pathology for decompression of nerves. The pedicular approach or transfacet approach is adopted for decompression of the nerve more laterally in the foramen or extra-foraminally. Both may not be concurrently reported at the same interspace level.

Far lateral disc herniation: Far lateral lumbar disc herniation is an uncommon condition. Unlike a typical disc herniation, the nerve roots are compressed outside the vertebral canal in the course of the spinal nerves outside the foramina.

The midline approach: Your surgeon may make a midline skin incision in far lateral disc herniation but may not apply the traditional midline interlaminar approach for the exploration. The interlaminar approach may not provide an adequate visualisation of the extraspinal nerve as the course of the nerve is hidden by the intervertebral articulation.

Alternate approach for far lateral lumbar disc herniation: Some approaches that your physician may use for the far lateral herniation include the paramedian muscle-splitting microtechnique and the enlarged midline approach.