Nicole Posted Thu 28th of September, 2017 13:43:27 PM
Patient has epidural abscess at L2-3 along with spinal stenosis that extends to the L4-5. The doctor performed a bilateral laminectomy from the L2-L5 which would be 63047 and 63048 x3. Question I have is the doctor also removed an abscess from the L2-3 disk level. Would the 63267 be billed for the L2-3 since the Laminectomy was done but the abscess was removed from the interspace area.
So basically would I be billing: 63267 (L2), 63047 (L3), 63048x2 (L4, L5) OR would it be 63267 (L2-3), 63047 (L4), 63048 (L5)
SuperCoder Answered Fri 29th of September, 2017 08:50:51 AM
If the abscess removal was small and was kind of incidental you would bill the 63047. If it was large and was causing the compression you would probably look at the 63267 code.
If the abscess was complicated, you should report 63267 (Laminectomy for excision or evacuation of intraspinal lesion other than neoplasm, extradural; lumbar) just once for the surgery the neurosurgeon performed on L2 and L3. Then, use 63047 (Laminectomy, facetectomy and foraminotomy [unilateral or bilateral with decompression of spinal cord, cauda equina and/or nerve root(s) (e.g., spinal or lateral recess stenosis)], single vertebral segment; lumbar) for the laminectomy.
Be sure to append modifier 59 (Distinct procedural service) to 63047 to indicate that the two surgical procedures were separate and distinct.
Usually, the codes for laminectomy and intraspinal lesion excision (63265-63290) are regional, covering however many levels there are in any spinal area (cervical, thoracic or lumbar). Whether you can separately code a decompressive laminectomy that your physician completes at an adjacent level for stenosis may depend on how unrelated the diagnoses are.
63267 can be used if the excision is more involved such as adherent to the dura however, there are no additional segment codes that can be reported with this code. If the surgery was to remove the abscess use the 63267 code, if the primary reason for the surgery was the laminectomy and the abscess removal was incidental, use 63047 and 63048 for each additional level.
Nicole Posted Fri 29th of September, 2017 09:27:36 AM
So if the MRI scan showed evidence of compressive epidural abscess at L2-3 along with spinal stenosis that extended to the L4-5 level, I would code the 63267 (L2-L3), 63047 -59 (L4) and 63048 (L5).
SuperCoder Answered Tue 03rd of October, 2017 02:29:18 AM
Yes you can code 63267 (L2-L3), 63047 -59 (L4) and 63048 (L5).