Neurosurgery Coding Alert

Reducing claim denials and payment delays for laminectomies and laminotomies often comes down to educating the carrier about the differences between these procedures, and why it may be necessary to perform them at the same time. Changes made in CPT 2001 to the laminectomy and laminotomy codes will make this task easier for neurosurgery coders. Gaining a full understanding of these changes along with the clinical nature of the two procedures and the appropriate modifiers to accompany the codes should give neurosurgery coders the advantage necessary to ensure speedy reimbursement for these claims.

Clinical Knowledge is Essential to Successful Claims

Surgeries like this are often performed to relieve compression of the spinal cord caused by a bone displaced in an injury or accident or degeneration of a disc. To access the spinal cord, a portion of the vertebrae near the affected area may need to be removed.

The small bony arch that is either partially chipped away or completely removed is called the lamina or laminae. A laminotomy is the excision of the upper and lower portions of the adjacent laminae (e.g., at the vertebral interspace). A laminectomy is the removal of the entire lamina from a single vertebral segment. Sometimes a neurosurgeon needs to remove part of the lamina above or below the excised level to gain full access to the nerve roots and disk. Fusion is occasionally needed.

When coding for a laminotomy or a hemilaminectomy use 63020 (laminotomy [hemilaminectomy], with decompression of nerve root[s], including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disk; one interspace, cervical) or 63030 (... one interspace, lumbar [including open or endoscopically assisted approach]) depending on the surgical site.

When doing this procedure bilaterally, use the same code and apply modifier -50 (bilateral procedure), says Richard D. Bucholz, MD, professor and associate director of the division of neurosurgery at St. Louis University in Missouri. Medicare and nearly all commercial insurance companies accept modifier -50 and pay more for the procedure when done on both sides, increasing the fee by 50 percent. This is also true for laminotomies at additional levels (+63035, laminotomy [hemilaminectomy], with decompression of nerve root[s], including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disk; each additional interspace, cervical or lumbar [list separately in addition to code for primary procedure]), which can also be used with modifier -50 when done bilaterally.

Coding for Laminotomy

CPT 2001 has revised the codes for a re-exploration of a laminotomy. Codes 63040 (laminotomy [hemilaminec-tomy],with decompression of nerve root[s], including partial facetectomy, foraminotomy and/or excision of herniated interveterbral disk, re-exploration, single interspace; cervical) and 63042 (... lumbar) now apply to a single interspace. This change was required by the introduction of two new [...]