Correctly coding for lumbar laminectomy and laminotomy is a puzzle for many coders. CPT Codes 2002 includes a range of codes that seemingly describe various surgical options, but even the most experienced coders admit that these descriptions don't always fit the operative notes. Marvel J. Hammer, RN, CPC, president of MJH Consulting in Denver, says, It is important for the coder to answer the following questions prior to selecting the correct CPT code:
What procedural prefixes and suffixes (e.g., hemi-, -ectomy, -otomy) are noted in the documentation? Were any other additional anatomic structures removed or altered during the surgery (e.g., the vertebral foramina, facets, disks)? What part of the spine is the surgery on (e.g., cervical, thoracic, lumbar)? How many segments or interspaces are documented in the surgery note? Is this the first surgery or a re-exploration?""
The key to correct coding and billing lies in matching the CPT descriptors with the surgeon's notes and ensuring that the diagnosis supports medical necessity. ""It is essential that the coder have a clear understanding of what surgery was actually performed. This may involve assisting the physician to better document the procedures performed,"" Hammer says.
Understanding the Anatomic Terms
An accurate definition for medical terms is important to correct coding. A vertebral segment or body is one complete vertebral bone with its associated articular processes and laminae, e.g., L1, L2, L3. A vertebral interspace is the nonbony compartment between two adjacent vertebral segments and contains the intervertebral disk, e.g., L2-L3.
Laminectomy is the removal of all or part of the posterior arch (including the spinous process) of a vertebral body. Laminotomy (also referred to as hemilaminectomy) is the partial or complete removal of the bony lamina of one side of the vertebral body. Laminectomy and laminotomy can also include foraminotomy (opening or enlarging of the foramin), facetectomy (partial or complete removal of the facet), and excision of a herniated intervertebral disk. The goal of these procedures is to decompress the nerves of the spinal cord by enlarging the spinal canal.
When more conservative therapies (such as physical therapy, anti-inflammatory medication, and epidural steroid injections) do not adequately relieve the patient's symptoms, surgical intervention is often recommended. Decreased pain, weakness, and/or numbness in the legs or buttocks are the expected outcome following surgery.
According to the local medical review policies (LMRP) for Alabama Blue Shield, the state's Medicare Part B carrier, ""Laminectomy is indicated for, but not limited to, spinal stenosis (e.g., 724.02, lumbar region) as a result of spondylosis, degenerative spondylolisthesis, developmental stenosis, trauma, metabolic processes, or prior surgery."" Their LMRP lists a number of ICD-9 codes that support the medical necessity [...]