Go Back   AAPC Medical Coding & Billing Forums > Medical Coding > General Discussion
Forum Rules FAQ Members List Calendar Search Today's Posts Mark Forums Read

Reply
 
Thread Tools
  #1  
Old 01-07-2013, 09:24 AM
ms.coderll ms.coderll is offline
New
 
Join Date: Apr 2007
Posts: 8
ms.coderll is on a distinguished road
Question 63030 vs. 63047

Can someone please explain to me in the simplest terms what the difference between 63030 and 63047 is? I know easier said than done. I am having a issue trying to code a case because I can not find the distinct differences between the two codes. Patients dx is Herniated Nucleus Pulposus and Lateral Recess Stenosis. Surgery performed is Left L4-L5 Hemilaminectomy and discectomy and placement of epidural fat graft.

A new coding company we are out sourcing these cases to coded 63030 and 63710.

The doctor coded 63047, 63048 and 15770. Now I have to explain who is correct ugh.

I am so confused Thanks
Reply With Quote
  #2  
Old 01-07-2013, 03:07 PM
magnolia1 magnolia1 is offline
Expert
 
Join Date: Apr 2007
Location: Albany, New York
Posts: 456
magnolia1 is on a distinguished road
Default

Quote:
Originally Posted by ms.coderll View Post
Can someone please explain to me in the simplest terms what the difference between 63030 and 63047 is? I know easier said than done. I am having a issue trying to code a case because I can not find the distinct differences between the two codes. Patients dx is Herniated Nucleus Pulposus and Lateral Recess Stenosis. Surgery performed is Left L4-L5 Hemilaminectomy and discectomy and placement of epidural fat graft.

A new coding company we are out sourcing these cases to coded 63030 and 63710.

The doctor coded 63047, 63048 and 15770. Now I have to explain who is correct ugh.

I am so confused Thanks
Based on my understanding of how these codes read in the CPT book, and the corresponding procedure descriptions in the Coders Desk Reference, 63030 would apply to a "vertebral interspace" while 63047 would apply to a "vertebral segment". Description of CPT 63047 does not reflect any disc removal.
Without a copy of your Operative report available for review, but based on the way your procedure is worded above.....it appears as though one "interspace" was addressed and a dural fat graft (CPT 63710) was performed. I would say that your outsourcing company is correct. CPT 15770 is definitely incorrect (that code is from the Integumentary System Section and would not be used in this scenario)
__________________
Karen Maloney, CPC
Data Quality Specialist
Reply With Quote
  #3  
Old 01-08-2013, 06:47 AM
ms.coderll ms.coderll is offline
New
 
Join Date: Apr 2007
Posts: 8
ms.coderll is on a distinguished road
Default

Thank you so much for your help on this. I agreed with the coding company as well for the graft.
Reply With Quote
  #4  
Old 01-08-2013, 08:58 AM
magnolia1 magnolia1 is offline
Expert
 
Join Date: Apr 2007
Location: Albany, New York
Posts: 456
magnolia1 is on a distinguished road
Default

You are welcome.

I forgot to mention that Medicare and Medicaid consider CPT 63710 an
"Inpatient Only" procedure.
And depending on the circumstance (as noted in CPT Assistant below), the dura
graft may be included with CPT 63030:

To further clarify usage, code 63030 may be reported only when an open surgical technique (not an endoscopic approach/technique) is used and the intrinsic essential components of this code are performed; namely, a resection of the vertebral component, spinous processes, and lamina, which must include a discectomy, for decompression of the nerve root(s), as well as any laminotomy or laminectomy foraminotomy along with partial facetectomy, as needed for decompression of the nerves or required as part of the surgical approach. The repair of small intraoperative dural laceration or leak, and harvesting and placement of soft tissue graft, muscle, or fat when obtained from within the primary surgical incision, are considered part of the intraservice work and are not reported separately. If laminotomy with decompression of nerve root(s) is not performed, then it would not be appropriate to report code 63030 for the excision of the herniated intervertebral disc. However, code 63030 may be reported for an open procedure involving the use of a tubular retractor and endoscopic illumination and visualization rather than microscopic illumination and visualization.
__________________
Karen Maloney, CPC
Data Quality Specialist
Reply With Quote
Reply

Thread Tools

Posting Rules
You may not post new threads
You may not post replies
You may not post attachments
You may not edit your posts

BB code is On
Smilies are On
[IMG] code is On
HTML code is Off




Disclaimer: Although AAPC staff members will monitor these forums periodically, we cannot be responsible for the information posted herein, nor guarantee its accuracy. Our members may discuss various subjects related to medical coding, but none of the information should replace the independent judgment of a physician for any given health issue. Please note that the opinions expressed here do not necessarily reflect those of AAPC.

All times are GMT -6. The time now is 06:39 PM.

AAPC - Top

Powered by vBulletin® Version 3.8.1
Copyright ©2000 - 2014, Jelsoft Enterprises Ltd.
Copyright ©2014, AAPC