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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?
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).
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!