Wiki 63047 and nerve root pairs

[coderguy1939]

Can someone please explain to me nerve root pairs as they relate to 63047. I've read the AAOS August 2004 Bulletin on spinal procedures and am still unsure of how to count nerve pairs.

The Bulletin states:

"For example, if just the L5 roots are seen with an L4/L5 lami, code 63047 Laminectomy, facetectomy and foraminotomy (unilateral or bilateral w/decompression of spinal cord, cauda equina and/or nerve root(s) (eg, spinal or lateral recess stenosis), single verteral segment, lumbar".

Let's stop there and discuss. What are the L5 root pairs? And does someone have a diagram they can refer me to so I can see the darn things?

The Bulletin then goes on to say:

"If both the L4 and L5 root pairs are seen in this procedure, codes 63047 and 63048 would be used. The documentation must supoor the root levels being decompressed.

Any help would be appreciated.

 

[RebeccaWoodward*]

When my surgeon(s) perform this procedure, they document that both nerves (i.e. L4/L5) are visualized and both are decompressed. We have never had problem with reimbursement; even if the carriers request documentation. Maybe the videos below will help.

http://www.spine-health.com/information/anatomy-videos

Also-

http://www.apparelyzed.com/spinalcord.html

 

[coderguy1939]

Hi, Rebecca,

Thanks for your response.

I looked at the second website you sent me and looked at the single vertebral segment diagram. The dorsal nerve root and the ventral nerve root can be seen branching off of the spinal nerve on each side of the vertebra. Let's say for arguments sake that this is the L5 vertebra. What constitutes the "pair" being referred to in the AAOS Bulletin. From what I can determine there seems to be two pairs on either side of the vertebra.

I have an op report where the doctor states:

"the L5 nerve root was fully decompressed and easily palpatated and visible under high ocular magnification as being completely free of any surrounding bony or soft tissue impingement. Likewise, the S1 nerve roots were fully decompressed and visualized."

When he refers to L5 he states nerve root (singular) and when he refers to S1 he states nerve roots (plural).

I'm coding 63047 and 63048.

Maybe I'm over-thinking this but I'd appreciate any further insights you might have on this.

Thanks,
David

 

[RebeccaWoodward*]

Since 63047 is inherently bilateral, I'm of the opinion that you can only report 63047/63048 for the visualized, decompressed nerves of L5/S1. I agree with you for reporting 63047/63048.

 

[coderguy1939]

Thanks, Rebecca. As always, I appreciate your assistance.