Orthopedic Coding Alert

Laminoplasty may still be considered an unlisted procedure, but you can recoup reimbursement for this $1,200+ surgery if you follow three simple rules.

Don't Equate It With Laminectomy

Open-door laminoplasty is an alternative treatment for spinal stenosis (723.0, cervical; 724.00-724.09, Other than cervical), or narrowing of the spinal canal. Although a viable option, decompressive laminectomy (63001-63017) - during which the surgeon removes the entire lamina at one or more vertebral segments to reduce pressure on the spinal cord - often results in complications such as instability, kyphotic deformity and postlaminectomy syndrome, which may require fusions that severely curtail mobility.
 
In contrast, open-door laminoplasty decompresses the spinal cord while retaining structural support for the vertebral column, says Donald D. Dietze, MD, a surgeon with the North Institute in Covington, La. The surgeon cuts through the lamina on one side of the spinous process (the tips of which are removed) at the affected levels and notches the lamina on the opposite sides to create a "hinge" on which to open the posterior segment of the vertebra and release the spinal cord. The surgeon then places 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.
 
Because this surgery is unique, you should carefully follow three essential steps to ensure reimbursement.

Step 1: Report the Unlisted-Procedure Code. CPT does not include a code to describe open-door laminoplasty. Therefore, Heidi Stout, CPC, CCS-P, coding and reimbursement manager at University Orthopaedic Associates in New Brunswick, N.J., suggests that coders report 22899 (Unlisted procedure, spine) for the procedure.
 
In addition to 22899, you should separately report the appropriate spinal graft harvest code (20930-20938).
 
Although the procedures are associated, an open-door laminoplasty is more complex and time-consuming than a typical laminectomy and includes both excision and fusion elements. Because CPT and many coding experts advise against using the "next-best" code when reporting a procedure without a dedicated CPT descriptor, do not report 63001-63017 for open-door laminoplasty. Even if you append modifier -22 (Unusual procedural services) to the claim, the payer is unlikely to give it the consideration and scrutiny it deserves - meaning you will not likely receive the payment you deserve, either.

Step 2: Do Not Append -51 for Additional Levels. Contrary to what most orthopedic practices believe, you should not report 22899-51 (Multiple procedures) to describe additional laminoplasty levels.
 
According to the April 2001 CPT Assistant, "When performing two or more procedures that require the use of the same unlisted code, the unlisted code used should only be reported once to identify the services provided. Unit values are not assigned to unlisted codes since the codes do not identify usual procedural components or the effort/skill required for the service."
 
Therefore, Stout says, you should report 22899 just once, without modifier -51 appended.
 
Step 3: Include an Operative Report and a Letter With Your Claim. Reporting an unlisted-procedure code will get the payer's attention, but without proper documentation you'll likely receive a rejection or minimal reimbursement. The operative report must reflect your additional work and effort as much as possible - the more detailed the dictation, the better.
 
You should attach a letter - in which the surgeon explains the nature of the procedure and the precision and time involved - to your claim. Such documentation takes time, but it's worth the effort in this case. (See our sample laminoplasty letter at right.)
 
Although you do not want to report open-door laminoplasty as laminectomy, it helps the payer if you compare the two procedures, noting how they are different and how they are similar. To further clarify what the laminoplasty entailed, note the time it normally takes for you to perform each of the procedures.
 
For reimbursement purposes, most practices compare laminoplasty to code 63001 (Laminectomy with exploration and/or decompression of spinal cord and/or cauda equina, without facetectomy, foraminotomy or diskectomy [e.g., spinal stenosis], one or two vertebral segments; cervical) or 63015 (Laminectomy with exploration and/or decompression of spinal cord and/or cauda equina, without facetectomy, foraminotomy or diskectomy [e.g., spinal stenosis], more than 2 vertebral segments; cervical).