yulianikmiller@hotmail.com
Contributor
Can you please advise on correct coding for service performed on L4-L5 level. Since only posterolateral fusion was done on this level, we billed decompression with CPT code 63047 as CPT code 63052 can not be reported with CPT code 22614 or 22612. How should we code for decompression that performed on a level where posteriolateral fusion only done.
After MR review an insurance denied service reported with CPT code 63047 by stating the code is bundled with CPT code 22633. Review states the provider assigned CPT code 63047 (Laminectomy, facetectomy and foraminotomy (unilateral or bilateral with decompression of spinal cord, cauda equina and/or nerve root, [eg, spinal or lateral recess stenosis]), single vertebral segment; lumbar) with modifier 51; however, this code and modifier have been incorrectly assigned per the physician operative note submitted. The submitted documentation indicates that the service was performed for decompression of L2-S1 with interbody fusion of L2-L3, L3-L4, and LS-S1. The documentation does not support a laminectomy with facetectomy and foraminotomy at a separate structure from the sites of the interbody fusions
The claim has been codes as
22633 L5-S1
22634 X 2 L3-L4, L2-L3
63052 XS L5/S1
63053 X 2 L3/L4, L2/L3
22614 L4-L5
63047, XS L4/L5
22853 x 2 L2-L3, L3-L4, L5-S1
22842 L2-S1
Here is Op report
PREOPERATIVE DIAGNOSES:
L5-S1 grade I spondylolisthesis with axial back pain, radiculopathy.
L4-L5, L3-L4, and L2-L3 spinal stenosis with axial back pain, neurogenic claudication, radiculopathy.
POSTOPERATIVE DIAGNOSES:
L5-S1 grade I spondylolisthesis with axial back pain, radiculopathy.
L4-L5, L3-L4, and L2-L3 spinal stenosis with axial back pain, neurogenic claudication, radiculopathy.
PROCEDURES PERFORMED:
Minimally invasive L5-S1 right-sided approach for posterior decompression.
Minimally invasive right L5-S1 transforaminal lumbar interbody fusion with Catalyft expandable interbody cage with autograft, allograft, and DBF.
Open reduction of grade I spondylolisthesis at L5-S1.
L4-L5 posterior decompression, minimally invasive.
Direct decompression of right L4-L5 foramen and right L4 nerve.
Attempted interbody graft placement at L4-L5 and noticing that L4-L5 was autofused at this point.
L3-L4 minimally invasive posterior decompression.
L3-L4 right-sided approach for Catalyft expandable interbody cage with autograft, allograft, and DBF.
L2-L3 posterior decompression.
Right-sided L2-L3 Catalyft expandable interbody cage with autograft, allograft, and DBF.
O-arm neuronavigation guided bilateral L2-S1 posterior segmental instrumentation.
L2 to S1 instrumented posterior spinal fusion.
Use of intraoperative microscope.
Use of neuronavigation to drill the bilateral proximal TP and lateral facet
DESCRIPTION OF PROCEDURE: The patient was brought to the operating room on a gurney and general endotracheal anesthesia was then induced. After ET tube and lines were secured, the patient was turned prone onto a Jackson table. All
pressure points were adequately padded at this time. Surgical site area was then prepped and draped in a sterile fashion. After the draping was done, paraspinal incision was given on the right side, centered over the L2 to S1 pedicle screw entry points. Serial dilators were then used and we docked a working channel sheath initially over the L5-S1 on the right side. I then brought to the operating microscope and drilled the bottom lamina of L5, top lamina of S1, and the medial facet of L5-S1 on the right side. Then, used a Kerrison 2 and 3 mm punch to do a laminotomy and medial facetectomy. After decompressing the central canal and the bilateral lateral recess, I did diskectomy at L5-S1 space, did appropriate endplate prep and placed a size 7 Catalyft expandable interbody cage with autograft, allograft, and DBF in the anterior interspace. I noticed good open reduction of grade I spondylolisthesis.
I then moved up to the L4-L5 space and drilled the bottom lamina of L4, top lamina of L5, and the medial three fourths facet of L4-L5 on the right side. Then, used a Kerrison 2 and 3 mm punch to do a laminotomy and medial facetectomy. After decompression of central and lateral recess, I tried to do diskectomy at L4-L5 space and noticed that there was autofusion which was taken place. I hence did not try to attempt to fuse this area because it was autofused. I then moved on to decompressing the foramen on the right and confirming right L4 nerve was completely freed up in the foramen.
At this point, I achieved hemostasis, moved up to the L3-L4 space, drilled the bottom lamina of L3, top lamina of L4 and the medial three fourths facet of L3-L4 on the right side and used a Kerrison 2 and 3
mm punch to do a laminotomy and medial facetectomy. I decompressed the central lateral recess on both sides. then did diskectomy at L3-L4 space. After confirming decompression of central canal and the bilateral lateral recesses at L3-L4, I did diskectomy of the L3-L4 space and then placed a size 7 Catalyft expandable interbody cage with autograft, allograft, and DBF in the anterior interspace after a complete good endplate prep was done. I then moved up to the L2-L3 space, drilled the bottom lamina of L2, top lamina of L3, and the medial facet of L2-L3 on the right side.
Then, used a Kerrison 2 and 3 mm punch to do a laminotomy and medial facetectomy. I decompressed the central lateral recess on both sides, did a diskectomy. After confirming decompression of central canal and the bilateral L3 nerves in the lateral recess, I did diskectomy at L2-L3 space on the right side, did appropriate endplate prep and placed a size 7 Catalyft expandable interbody cage with autograft, allograft, and DBF in the anterior interspace.
At this point, I achieved hemostasis. I made an incision on the iliac crest on the right and did O-arm registration. After satisfactory registration was achieved, percutaneous pedicle screws were placed into S1, L4, L3, and L2 on the
right; L2, L3, L5 and S1 on the left. I then confirmed with fluoroscopy that the screws were in good position and stable alignment. I passed a percutaneous rod, applied set screws and torqued them off. Wound was then irrigated with copious amounts of antibiotic saline. We achieved hemostasis . At this point, I used the navigation to drill the proximal TP and the lateral facet of L2-L3, L3-L4, L4-L5, and L5-S1 on both sides and placed autograft and DBF for posterolateral fusion. I then passed an appropriate percutaneous rod, applied set screws and torqued them off. Closure was then done in layers using O Vicryls for the fascia and subcutaneous tissue and 2-0 nylon for the skin.
There were no intraoperative complications. Sponge and needle counts x2 at the end of procedure, correct.
After MR review an insurance denied service reported with CPT code 63047 by stating the code is bundled with CPT code 22633. Review states the provider assigned CPT code 63047 (Laminectomy, facetectomy and foraminotomy (unilateral or bilateral with decompression of spinal cord, cauda equina and/or nerve root
The claim has been codes as
22633 L5-S1
22634 X 2 L3-L4, L2-L3
63052 XS L5/S1
63053 X 2 L3/L4, L2/L3
22614 L4-L5
63047, XS L4/L5
22853 x 2 L2-L3, L3-L4, L5-S1
22842 L2-S1
Here is Op report
PREOPERATIVE DIAGNOSES:
L5-S1 grade I spondylolisthesis with axial back pain, radiculopathy.
L4-L5, L3-L4, and L2-L3 spinal stenosis with axial back pain, neurogenic claudication, radiculopathy.
POSTOPERATIVE DIAGNOSES:
L5-S1 grade I spondylolisthesis with axial back pain, radiculopathy.
L4-L5, L3-L4, and L2-L3 spinal stenosis with axial back pain, neurogenic claudication, radiculopathy.
PROCEDURES PERFORMED:
Minimally invasive L5-S1 right-sided approach for posterior decompression.
Minimally invasive right L5-S1 transforaminal lumbar interbody fusion with Catalyft expandable interbody cage with autograft, allograft, and DBF.
Open reduction of grade I spondylolisthesis at L5-S1.
L4-L5 posterior decompression, minimally invasive.
Direct decompression of right L4-L5 foramen and right L4 nerve.
Attempted interbody graft placement at L4-L5 and noticing that L4-L5 was autofused at this point.
L3-L4 minimally invasive posterior decompression.
L3-L4 right-sided approach for Catalyft expandable interbody cage with autograft, allograft, and DBF.
L2-L3 posterior decompression.
Right-sided L2-L3 Catalyft expandable interbody cage with autograft, allograft, and DBF.
O-arm neuronavigation guided bilateral L2-S1 posterior segmental instrumentation.
L2 to S1 instrumented posterior spinal fusion.
Use of intraoperative microscope.
Use of neuronavigation to drill the bilateral proximal TP and lateral facet
DESCRIPTION OF PROCEDURE: The patient was brought to the operating room on a gurney and general endotracheal anesthesia was then induced. After ET tube and lines were secured, the patient was turned prone onto a Jackson table. All
pressure points were adequately padded at this time. Surgical site area was then prepped and draped in a sterile fashion. After the draping was done, paraspinal incision was given on the right side, centered over the L2 to S1 pedicle screw entry points. Serial dilators were then used and we docked a working channel sheath initially over the L5-S1 on the right side. I then brought to the operating microscope and drilled the bottom lamina of L5, top lamina of S1, and the medial facet of L5-S1 on the right side. Then, used a Kerrison 2 and 3 mm punch to do a laminotomy and medial facetectomy. After decompressing the central canal and the bilateral lateral recess, I did diskectomy at L5-S1 space, did appropriate endplate prep and placed a size 7 Catalyft expandable interbody cage with autograft, allograft, and DBF in the anterior interspace. I noticed good open reduction of grade I spondylolisthesis.
I then moved up to the L4-L5 space and drilled the bottom lamina of L4, top lamina of L5, and the medial three fourths facet of L4-L5 on the right side. Then, used a Kerrison 2 and 3 mm punch to do a laminotomy and medial facetectomy. After decompression of central and lateral recess, I tried to do diskectomy at L4-L5 space and noticed that there was autofusion which was taken place. I hence did not try to attempt to fuse this area because it was autofused. I then moved on to decompressing the foramen on the right and confirming right L4 nerve was completely freed up in the foramen.
At this point, I achieved hemostasis, moved up to the L3-L4 space, drilled the bottom lamina of L3, top lamina of L4 and the medial three fourths facet of L3-L4 on the right side and used a Kerrison 2 and 3
mm punch to do a laminotomy and medial facetectomy. I decompressed the central lateral recess on both sides. then did diskectomy at L3-L4 space. After confirming decompression of central canal and the bilateral lateral recesses at L3-L4, I did diskectomy of the L3-L4 space and then placed a size 7 Catalyft expandable interbody cage with autograft, allograft, and DBF in the anterior interspace after a complete good endplate prep was done. I then moved up to the L2-L3 space, drilled the bottom lamina of L2, top lamina of L3, and the medial facet of L2-L3 on the right side.
Then, used a Kerrison 2 and 3 mm punch to do a laminotomy and medial facetectomy. I decompressed the central lateral recess on both sides, did a diskectomy. After confirming decompression of central canal and the bilateral L3 nerves in the lateral recess, I did diskectomy at L2-L3 space on the right side, did appropriate endplate prep and placed a size 7 Catalyft expandable interbody cage with autograft, allograft, and DBF in the anterior interspace.
At this point, I achieved hemostasis. I made an incision on the iliac crest on the right and did O-arm registration. After satisfactory registration was achieved, percutaneous pedicle screws were placed into S1, L4, L3, and L2 on the
right; L2, L3, L5 and S1 on the left. I then confirmed with fluoroscopy that the screws were in good position and stable alignment. I passed a percutaneous rod, applied set screws and torqued them off. Wound was then irrigated with copious amounts of antibiotic saline. We achieved hemostasis . At this point, I used the navigation to drill the proximal TP and the lateral facet of L2-L3, L3-L4, L4-L5, and L5-S1 on both sides and placed autograft and DBF for posterolateral fusion. I then passed an appropriate percutaneous rod, applied set screws and torqued them off. Closure was then done in layers using O Vicryls for the fascia and subcutaneous tissue and 2-0 nylon for the skin.
There were no intraoperative complications. Sponge and needle counts x2 at the end of procedure, correct.