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Removal of a synovial cyst at the same level as a laminectomy

Deborah h Posted Sun 25th of October, 2015 12:55:27 PM

Would you charge for both the removal of the synovial cyst and the laminectomy at the same level; if the laminectomy was done for decompression as well? In this scenario where L2-L3, L3-L4, synovial cyst removed at L3-L4 and a laminectomy done L2-L3 AND L3-L4. How would this scenario be coded? Please list sources?

SuperCoder Answered Mon 26th of October, 2015 04:19:54 AM


For the synovial cyst at level L3-L4 the correct code would depend on the location of the cyst. If it is extradural (outside the dura mater) then the code is 63267 (laminectomy for excision or evacuation of intraspinal lesion other than neoplasm, extradural; lumbar) with modifier -22 (unusual procedural services) to reflect the second level. If the cyst was intradural (enclosed in the dura), the code would be 63272 (laminectomy for excision of intraspinal lesion other than neoplasm, intradural; lumbar). In addition, the codes for removal of an intraspinal lesion include the laminectomy, and the coder cannot code for additional levels involved in the lesion removal.

In this case, the laminectomy done at the L2-L3 level can be coded separately because the cyst was only at the L3-L4 level. Depending on the extent, the coder might also code 63005 (laminectomy with exploration and/or decompression of spinal cord and/or cauda equina, without facetectomy, foraminotomy or diskectomy, [e.g., spinal stenosis], one or two vertebral segments; lumbar, except spondylolisthesis) with modifier -51 (multiple procedures) for the L2-L3 laminectomy.

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