Neurosurgery Coding Alert

Make sure you're not confusing spinal segments with interspaces To code correctly for laminectomy and hemilaminectomy (laminotomy), you must know whether the surgeon removes one or more complete lamina from a single vertebra or if he partially removes the lamina from two adjacent vertebrae. Report Laminectomy per Segment When choosing laminectomy codes, you should report the procedure per spinal segment, says Eric Sandhusen, CHC, CPC, director of billing and fiscal compliance for Columbia University Department of Surgery. CPT provides three primary codes and one add-on code to describe laminectomy with decompression: 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 +63048 - ... each additional segment, cervical, thoracic, or lumbar (list separately in addition to code for primary procedure). During laminectomy, the surgeon removes the spinous process (the bony projection on the back of the vertebrae) and one or both lamina (the broad plates of bone on either side of the spinous process that complete the arch"" of the vertebrae and enclose the spinal cord)" followed by decompression of nerves says Kee D. Kim MD associate professor of neurosurgery at University of California Davis in Sacramento. The focus of the work is the individual vertebra and the nerve roots emanating through the foramen (passageways) on either side of the vertebra. The surgeon may perform laminectomy on several adjacent vertebral levels. Don't Apply Modifiers for Bilateral Laminectomy You should report 63045 63046 or 63047 as appropriate for the first spinal level the surgeon treats followed by 63048 for each additional level beyond the first.   In addition note that codes 63045-63048 are unilateral or bilateral. Therefore you should report the same code with no modifiers appended whether the surgeon removes one or both lamina of a particular vertebra Sandhusen says.   Example: To provide spinal cord and nerve decompression the surgeon removes the spinous process and left lamina of the third cervical vertebra (C3) as well as the spinous process and left and right laminae of the fourth cervical vertebra (C4). This would be called a C3-C4 laminectomy.   In this case you should report 63045 for the first spinal level (C3) the surgeon treats followed by 63048 for the subsequent spinal level (C4).   Even though the surgeon removes only a single lamina from C3 and both laminae from C4 you report each code "as is " with no modifiers appended.   Laminectomy w/o Decompression? Look Elsewhere If the surgeon performs laminectomy to relieve compression of the spinal cord or remove abnormal facets without nerve decompression you should choose from codes 63001-63017 [...]