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Spine Procedure

Diane Posted Tue 28th of January, 2020 16:23:50 PM
Doctor did Laminectomy at L4-L5 with discectomy and foraminotomy (63042), He also did Laminectomy at L3-4 with foraminotomy with removal of intraspinal synovial cyst at L3-L4. I used code 63267 which is laminectomy for excision of intraspinal lesion other than neoplasm. Workers' compensation with the Department of Labor states that 63267 is inclusive to 63042 even though it is a different level. The bill review people state I can file an appeal showing documentation that it is not inclusive. I think since it is at a different level it should not be inclusive, if the cyst was at the same level as L4-5 then yes it would be inclusive. Should I have just billed 63044 as an additional level so that it would not be inclusive. I don't have any documentation about billing 63267 along with 63042 I just thought since it was a different level it would pay. Please advise. Thank you.
SuperCoder Answered Wed 29th of January, 2020 06:26:11 AM

Hi,

 

As per the above-mentioned report, CPT 63042 and 63267 are the correct codes. Both procedures have been performed at different levels, so both the codes will be billed separately.

As per the CCI edits, CPT 63042 and 63267 can be billed together. Be sure to append modifier 59 (Distinct procedural service) to 63267 (it is a column 2 code for 63042) to indicate that the two surgical procedures were separate and distinct.

 

Please also check below links:

https://www.supercoder.com/coding-newsletters/my-neurosurgery-coding-alert/reader-question-confirm-laminotomy-vs--laminectomy-in-spinal-cyst-excision-154474-article

 

https://www.supercoder.com/coding-newsletters/my-neurosurgery-coding-alert/you-be-the-coder-which-code-best-describes-cyst-removal-article

 

https://www.supercoder.com/coding-newsletters/my-neurosurgery-coding-alert/reader-question-redo-laminectomies-article

 

 

Thanks

Diane Posted Wed 29th of January, 2020 10:20:32 AM
You advised to check the links, I evidently do not have access to the news letter since I am Orthopedic and the news letter is apparently under Neurosurgery. Is there a way that I can access it? Thank you. Diane
SuperCoder Answered Thu 30th of January, 2020 01:00:47 AM

Hi,

Thanks for your query.

 

The complete data for above mentioned newsletter links are as follows:

https://www.supercoder.com/coding-newsletters/my-neurosurgery-coding-alert/reader-question-confirm-laminotomy-vs--laminectomy-in-spinal-cyst-excision-154474-article

 

Reader Question:

Confirm Laminotomy vs. Laminectomy in Spinal Cyst Excision

 

Question: In a patient with right-sided radiculopathy, our surgeon diagnosed a synovial cyst. Our surgeon did an L4-L5 foraminotomy, decompression of the neural foramina, and synovial cyst removal in this patient. How can we report these services?

Idaho Subscriber

Answer: You should first confirm whether your surgeon did a laminotomy or laminectomy. In laminectomy, your surgeon removes the entire part of the bony lamina; in laminectomy, your surgeon removes only a part of the lamina, usually on one side.

You may consider submitting code 63030 (Laminotomy [hemilaminectomy], with decompression of nerve root[s], including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disc; one interspace, lumbar) for the laminotomy. The work units for the cyst excision are bundled into 63030.

Confirming that your surgeon did remove the lamina and performed a foraminotomy, another option includes reporting 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).

However, the most descriptive code to report a laminotomy/laminectomy, unilateral or bilateral, with foraminotomy and excision of synovial cyst is 63267 (Laminectomy for excision or evacuation of intraspinal lesion other than neoplasm, extradural; lumbar).

ICD-10: You should report the synovial cyst with M71.38 (Other bursal cyst, other site).

 

_________________________________________________________________________________________________

 

https://www.supercoder.com/coding-newsletters/my-neurosurgery-coding-alert/reader-question-redo-laminectomies-article

 

Redo Laminectomies

 

Question: In reference to "redo" coding, are the following codes appropriate?

  • L3 through L5 redo decompressive laminectomies: 63042, 63044, 63044
  • L1 and L2 total laminectomies: 63005
  • Removal of compressive epidural scar: L3-L5: 63267.

I have checked the CCI, and none of these codes are bundled.

 

Neurosurgery Listserv Discussion Group

Answer: Descriptors for 63042 (Laminectomy [hemilaminectomy], with decompression of nerve root[s], including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disk, reexploration, single interspace; lumbar) and +63044 ( each additional lumbar interspace [list separately in addition to code for primary procedure]) specify "interspaces," not levels. Therefore, assuming that laminectomy was performed at two interspaces (L3-L4 and L4-L5), only a single unit of 63044 should be reported with 63042.

 

"Redo" codes 63042 and 63044 are valued to reflect the extra work required when scarring is present from a previous surgery: Decompression may be necessary because of scar tissue, a severely herniated disc, etc. Therefore, charging separately for removal of compressive epidural scar using 63267 (Laminectomy for excision or evacuation of intraspinal lesion other than neoplasm extradural; lumbar) is not allowed and is "double dipping" (charging twice for the same procedure). Code 63267 is appropriate only if the surgeon removed an epidural scar or other lesion from a level that had not been previously operated on.

Laminectomy at the L1-L2 interspace is appropriately reported with 63005 (Laminectomy with exploration and/or decompression of spinal cord and/or cauda equina, without facetectomy, foraminotomy or diskectomy, [e.g., spinal senosis], one or two vertebral segments; lumbar). Therefore, proper coding for this operative session is 63005, 63042 and 63044.

Clinical and coding expertise for You Be the Coder and Reader Questions provided by Eric Sandham, CPC, compliance educator for Central California Faculty Medical Group, a group practice and training facility associated with the University of California at San Francisco in Fresno.

 

 

Hope this helps!

 

Thanks

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