Wiki 63030 vs 63047

[tpardo]

Hi - one of our physician surgery schedulers is submitting an authorization for a case and is torn between submitting 63030 vs 63047. The patient's diagnosis is herniation due to stenosis I know that these CPT codes are diagnosis driven but when both are included in the reason for the surgery which takes precedence. In addition, if the reverse was the scenario - stenosis at one level and herniation at the other how would we code?
I find that the physicians are submitting codes for the procedure they feel they are performing and then when the coders at the billing office code the case, the coding does not match up due to the op-report.
Trying to create an educational document so there is a clear definition for both scenarios.
Thanks so much

 

[nickelclaw]

stenosis takes precedence 63047(Coding Clinic 1stQ 2023)
If there is a redo w/o recurrent disc herniation code is in range 63045-63048(per CPT assistant July 2021)

if both separate site then 63047, 63030-XS or 59 by payer