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63030 VS 63047

Nicole Posted Wed 06th of June, 2018 15:43:22 PM
High-speed but was used to perform a laminectomy, foraminotomy and facetectomy at L3-4. The laminectomy was then extended down to the level of L4-5. A medial facetectomy and limited foraminotomy was performed as well and the L4 nerve root was decompressed. The thecal sac was thoroughly decompressed. A discectomy was performed at L3-4 where the disc appeared to be bulging. In the paracentral region at the L4-5 the disc did not appear to be as protuberant, therefore there was no discectomy performed. The diagnosis given is Lumbar stenosis and degenerative disc disease. My question: Since the laminectomy w/ discectomy was done at the L3-4 (63030) but only a laminectomy was done at the L4-5 (63047), what is the proper coding for this procedure?
SuperCoder Answered Thu 07th of June, 2018 05:29:19 AM

Hi Nicole,

As we see in the above report there was disc bulge at L3-L4 (laminectomy with discectomy was done). There was no disc bulge at L4-L5. There was nerve root decompression at L4 (laminectomy without discectomy was done). Please see below the explanation for what code to use with what diagnosis.

When the laminectomy or laminotomy is performed primarily for herniated discs and the decompression procedure is not the primary reason, CPT Code 63030 is used. When the laminectomy or laminotomy is performed primarily for spinal stenosis, the decompression procedure is the primary focus and if only a minor discectomy or no discectomy is performed in the procedure, then Code 63047 would be used.

Some more explanations to bill for these codes:

CPT 63030 for the discectomy is included in the 63047 (spinal stenosis) when performed at the same level, so 63047 should be only code reported for this scenario.

63047 and 63030-59 may both be reported when these separate procedures are performed at different levels. For example: decompression of stenosis at say L4-L5 and then a discectomy at L5-S1. Make sure you distinguish the different diagnosis for each code.

This is one of those cases where the diagnosis matters in how you pick the right CPT code. Therefore, the difference is the purpose of the procedure. You should report 63030 when laminotomy is performed with a discectomy to treat spinal disc. By contrast, Code 63047 is used to report procedures performed for lateral recess stenosis, for example, caused by either ligamentum flavum hypertrophy or facet arthropathy.Please feel free to ask for any further query.

 

Nicole Posted Thu 07th of June, 2018 09:03:30 AM
The MRI showed severe spinal stenosis at L3-4 with a lesser degree of stenosis at the L4-5 level. The most aggressive laminectomy was performed at the L3-4 level in addition to the discectomy at the L3-4 where the disc appeared to be bulging. So for this case, would the proper coding be 63047 (L3) and 63048 x2 (L4) (L5) if the primary reason for the procedure is the severe spinal stenosis and the disc bulge was just addressed since it was at the same level?
SuperCoder Answered Fri 08th of June, 2018 08:42:25 AM

Yes, it is correct to bill 63047 and 63048, but we will  not bill 63048 twice because this code represents complete single segment, If the diagnosis (primary reason) comes out to be just spinal stenosis. Hope it helps.

Nicole Posted Fri 08th of June, 2018 12:00:40 PM
Would it not be 63047 (L3), 63048 (L4) and 63048 (L5)?
SuperCoder Answered Mon 11th of June, 2018 08:50:56 AM

Since it is a code for complete segment, the only codes that will be billed is 63047 for L3-L4 and 63048 for L4-L5. Thank you.

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