Wiki 63030 or 63047?

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what do you guys think about the following 63030 or 63047 or both?


DX: Left L4-L5 disc herniation with left L5 radiculopathy

Procedure: Left L5 hemilaminotomy with foraminotomy and exploration of disc

Operative Procedure:

Under fluoroscopic control, a maidline skin incision was made over length of approximately 1.5cm in the lumbar region at what was called at L4-L5. The patient had a transitional vertebra and the result that of the level we were addressing was L4-L5 the level of the herniated disc on MRI. The wound was developed through the subcutaneous tissue, superficial and deep fascia subperiosteally on the left side to the lamina. fluoroscopy again demonstrated at the level. Partial laminectomy on the left at L4 was carried out and the ligamentum flavum at L4-L5 elevated and removed exposing the dura beneath. The L5 nerve root to be seen and a foraminotomy was performed in the root was tight prior to the decompression. It was draped over underlying tissue. this was carefully explored and found to be bone. The nerve root was gently mobilized medially and exploration from medially took place and there was no extruded disc. There was no protruded disc that could be easily entered, as the floor was quite hard. For confirmation purposes, fluoroscopy was again obtained and compared to the MRI from preoperatively. this demonstrated at the correct level and it was seen that there was osteophyte with some disc superficial through it. Considerable time had been last between the time of the MRI and the surgery.

We saw that the nerve root on the left, which was symptomatic side, was completely decompressed and no further exploration was indicated. The hemostasis was meticulously acquired and closure was carried out in the usual mannerwith 10cc of subcutaneous Marcaine.

thanks
 
I'm throwing this out since I'm curious as to what your opinions would be on this...Per CPT Assistant (Feb 2001)

Nervous System, Surgery, 63030, 63047 (Q&A)

Question

My physician performs surgery on the spine that includes laminectomy, decompression of the spine, facetectomy of the L2 vertebra, and laminotomy with excision of the intervertebral disk at L1. Can codes 63030 and 63047 be used to identify the specific procedures performed?
AMA Comment

If both a laminectomy and a laminotomy are performed on the spine at different levels, then it would be appropriate to report a separate code for each of the procedures performed. In response to your specific question, decompressive laminectomy performed at the L2 level would be reported using 63047, and decompressive laminotomy performed at L1 should be reported using 63030 to identify the specific services performed. Modifier -51, Multiple Procedures, should be appended to the secondary, additional procedure performed. *****************************************************************************
"Partial laminectomy on the left at L4 was carried out and the ligamentum flavum at L4-L5 elevated and removed exposing the dura beneath." 63005 since there isn't mention of a facetectomy, foraminotomy, discectomy?


"The L5 nerve root to be seen and a foraminotomy was performed in the root was tight prior to the decompression. It was draped over underlying tissue. this was carefully explored and found to be bone. The nerve root was gently mobilized medially and exploration from medially took place and there was no extruded disc. There was no protruded disc that could be easily entered, as the floor was quite hard. For confirmation purposes, fluoroscopy was again obtained and compared to the MRI from preoperatively. this demonstrated at the correct level and it was seen that there was osteophyte with some disc superficial through it. Considerable time had been last between the time of the MRI and the surgery. We saw that the nerve root on the left, which was symptomatic side, was completely decompressed and no further exploration was indicated." 63030?

Thoughts?
 
The primary purpose of 63047 is to relieve spinal stenosis. It appears, to me ,that the primary purpose for this particular scenario is to treat a herniated disc (63030).
 
You know that was my way of thinking too, but I recently read an article in one of Margie Scalley Vaught book (FAQ for orthopedics) where this is not always the case, When I get home, I will post it.
 
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