n Socioeconomics & Politics | Coding Q&A

Lumbar Laminectomy Code Review Clarification Several questions have been raised side of a recurrent disc level if stenosis Additional Notes regarding the coding information in- is present. As presented, the coding ac- The use of posterior fusion codes cluded in the "Lumbar Laminectomy curately describes the work performed. that encompass disc work (eg, Code Review" article published in the The revision discectomy code is a uni- 22630 and 22633) already take into July/August 2014 SpineLine (pp 29-31). lateral code. It does not represent an account the removal of lamina, NASS’ Coding Committee would like to additional laminectomy done on the facets and ligamentum flavum. offer the following clarifications. contralateral side. The interbody fusion codes also As presented, 63042 (R L4-5) is the were written assuming bilateral appropriate code to be reported for the interbody placement which requires Reporting Additional Work on recurrent disc herniation and 63047–51 bilateral decompression. In cases Contralateral Side of Recurrent Disc is the appropriate code to report the de- that require decompression plus Herniation compression performed at the separate fusion (L4-5 spondylolisthesis with The first item concerns the following interspace (L3-4). central and lateral recess stenosis), scenario appearing on pages 30-31: The confusion comes in reporting the only the fusion codes can be used. 3. Posterior lumbar two level laminectomy on the contralateral side of The wording above from the original Interspace laminectomy (L3-4, the recurrent disc herniation at L L4-5. article is incomplete and has led to ques- L4-5) with removal of recurrent As presented, 63048 is appropriate to tions. From the AMA CPT guidelines, disc herniation at right L4-5 represent the work done; however, this decompression when performed IS with bilateral foraminotomies, will likely be edited out as inclusive in separately reportable with the inter- no microscope used; 63042 at the same level. There is no easy body fusion codes, 22630 and 22633. solution for reporting the additional History: Central stenosis L3-4 and The point made in the original article is work done on the contralateral side of L4-5 with recurrent HNP R L4-5 that a certain amount of laminectomy the recurrent disc herniation. and prior microdiscectomy R L4-5 is required for the approach in order Other options for reporting may interspace to perform the interbody fusion. How- include 63042 with a 22 modifier ap- ever, when decompression of the nerve ICD-9/10; 724.02/ M48.06 pended if the performing surgeon feels roots requires more laminectomy than Spinal Stenosis, lumbar region the additional laminectomy Left L4-5 necessary for the performance of the in- without neurogenic Claudica- represents significantly—at least 20%- terbody fusion, this is separately report- tion; L3-4 & L4-5 25%—more work than performed for able. It is up to the performing surgeon ICD-9.10; 722.1/M51.16 the recurrent disc herniation alone. In to document in the operative report the Lumbar disc without myelopathy; both options presented above, payment areas of necessary decompression over sciatica due to displacement of will likely be delayed as the reporting is and above the laminectomy required intervertebral disc; R L4-5 likely to trigger a review. for interbody placement. Remember NASS supports the accurate report- Suggested coding: that 22630 and 22633 are valued for a ing of work performed during proce- bilateral procedure. If a unilateral TLIF 63042 Laminotomy (hemilami- dures. However, we acknowledge that is performed, any additional facet/ nectomy), with decompression of at times accurately reporting what has hemilaminectomy work performed on nerve roots(s); including partial been done will result in delays in pay- the opposite side is already included in facetectomy, foraminotomy and/ ment due to code edits in place. It is up the work value of the code. or excision of herniated disc, re- to the performing physician to decide Due to Correct Coding Initiative exploration, single interspace; whether the additional work is inciden- (CCI)* edits, this coding often will be LUMBAR R L4-5 tal to the greater procedure or if there edited out and may need to be appealed 63047 Laminectomy, facetectomy has been significant, additional work to for manual review. When there is medi- and foraminotomy (unilateral or justify reporting additional procedures. cal necessity for decompression of nerve bilateral) with decompression of roots requiring separate laminectomy spinal cord, cauda equina and/ Reporting Additional Laminectomy or more laminectomy than would be or nerve root(s); single LUMBAR Over and Above that Required for necessary for the interbody fusion alone, segment L3-4 Interbody Fusion this is reportable according to the AMA 63048 left hemilaminectomy lumbar An Additional Notes paragraph on pos- CPT manual. L4-5 terior fusion codes on page 31 included *CCI, the Correct Coding Initiative, the following: is a private contractor to CMS and is a In the above scenario, confusion is separate entity from the American Medi- created by what to do with the opposite cal Association.

44 SpineLine | September · October 2014 www.spineline-digital.org