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Spinolaminectomy

Diane Posted Wed 13th of March, 2019 15:00:15 PM
My doctor states he did a spinolaminectomy. I have not heard of a spinolaminectomy. He said that it is spinous process removal. THe operative report states Spinolaminectomy at L4, Spinolaminectomy L5. Which I think this is 63047, 63048. Then he lists hemilaminectomy L4-5 bilateral and Hemilaminectomy L5-S1 bilateral which would be 63030-50 and 63035-50. He also did foraminotomies at L4-5 and L5-S1 and thermoplasty of disc L5-S1 on the right. I feel that he is wanted me to bill 63047 and 63048 along with 63030 and 63035. Can I do that? I asked him how can you bill for a laminectomy and a hemilaminectomy at the same levels. He then stated that he had to remove the spinous process and when you google that spinous process removal is part of 63047, but I have to bill for the hemilaminectomy too, so can I bill all of these codes? May with a -22 modifier ? Help I am so confused.
SuperCoder Answered Thu 14th of March, 2019 03:59:04 AM

Hi,

When your physician documents spinolaminectomy , you should turn to your laminectomy codes. During a laminectomy, the neurosurgeon removes the spinous process (the bony projection on the back of the vertebrae) and both lamina (the posterior, broad plates of bone that complete the “arch” of the vertebrae and enclose the spinal canal).

The big difference between the CPT 63030/63035 and 63047/63048 is purpose of the procedure,  CPT 63030 is used to treat spinal disc herniation. 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.

The interspace code 63030 (Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disc; 1 interspace, lumbar) is an integral part of the vertebral segment code 63047 (Laminectomy, facetectomy and foraminotomy (unilateral or bilateral with decompression of spinal cord, cauda equina and/or nerve root[s], [eg, spinal or lateral recess stenosis]), single vertebral segment; lumbar). 63047 includes removal of disc material above and/or below the vertebra being explored.

Even though the procedures are often done together, NCCI considers that extending the laminectomy to remove part of the adjacent lamina and enter the disk space doesn't add enough effort to justify separate billing. However, you can append modifier 59 (Distinct procedural service) if the neurosurgeon performs the laminotomy at a different level or side than the laminectomy. You can even add modifier 22 (Unusual procedural services) to 63047 at the same level/side if the physician documents sufficient additional work.

 

Thanks

 

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