Differentiate Laminectomies and Laminotomies for Optimum Results
Published on Tue Oct 01, 2002
Laminectomies and laminotomies are distinct procedures, but the similarities between them can cause confusion. To reduce denials and minimize coding errors, neurosurgery coders must know how to differentiate these procedures, apply modifiers appropriately and, if necessary, explain the differences and supply necessary medical documentation to uneducated payers. Laminectomy Distinguished by Complete Removal of Lamina During laminectomy, the surgeon removes the spinous process (the bony projection on the back of the vertebrae) and one or both lamina (the anterior, broad plates of bone that complete the "arch" of the vertebrae and enclose the spinal cord). When such complete laminectomies are done with nerve or facet joint decompression, the coding depends on the location of the affected vertebra(ae), as follows, says Richard D. Bucholz, MD, professor and associate director of the division of neurosurgery at St. Louis University in Missouri:
63045 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; cervical
63046 ... thoracic 63047 ... lumbar. As stated in the descriptors, these procedures may be unilateral or bilateral, and the same code, with no modifiers appended, is appropriate whether the surgeon removes one or both lamina of a particular vertebra. If the surgeon removes lamina from more than one vertebra, report each additional level using +63048 (... each additional segment, cervical, thoracic, or lumbar [list separately in addition to code for primary procedure]), Bucholz says. Note: When performing only laminectomy to relieve compression of the spinal cord without nerve decompression, report codes 63001-63017 (not 63045-63047) as appropriate (depending on the number and location of levels). Laminotomy Equals Partial Removal of Adjacent Laminae Laminotomy, also known as hemilaminectomy, involves removal of the upper and lower portions of adjacent laminae (i.e., the laminae on either side of a vertebral interspace) rather than the removal of the entire lamina(ae) of a single vertebra, as described by laminectomy. CPT contains seven codes to report laminotomy: 63020 Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disk; one interspace, cervical
63030 ... one interspace, lumbar (including open or endoscopically assisted approach)
+63035 each additional interspace, cervical or lumbar (list separately in addition to code for primary procedure)
63040 Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and/or excision of herniated interveterbral disk, re-exploration, single interspace; cervical
63042 ... lumbar
+63043 ... each additional cervical interspace (list separately in addition to code for primary procedure)
+63044 ... each additional lumbar interspace (list separately in addition to code for primary procedure)
Report an initial laminotomy using 63020 or 63030, depending on location, with +63035 for each [...]
