Neurosurgery Coding Alert

Question: I’m new to neurosurgery coding, having spent the past few years coding for a neurologist. I’m doing pretty well coding for procedures related to the brain, but the spinal procedures are difficult to grasp — particularly spinal decompression. Could you give me some examples of procedures the neurosurgeon might perform for spinal decompression?

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Answer: The codes for most of your spinal decompression procedures are in the 63001 (Laminectomy with exploration and/or decompression of spinal cord and/or cauda equina, without facetectomy, foraminotomy or discectomy (eg, spinal stenosis), 1 or 2 vertebral segments; cervical) through +63053 (Laminectomy, facetectomy, or foraminotomy (unilateral or bilateral with decompression of spinal cord, cauda equina and/or nerve root[s] [eg, spinal or lateral recess stenosis]), during posterior interbody arthrodesis, lumbar; each additional vertebral segment (List separately in addition to code for primary procedure)) code range. The definition of each of the procedures is the most important information you’ll need to learn to navigate these codes.

During her HEALTHCON 2025 presentation “Inside a Spinal Fusion,” Jennifer McNamara, CPC, CCS, CRC, CPMA, CDEO, CGSC, COPC, COSC, CEO of Healthcare Inspired, LLC, explained the differences among the spinal decompression procedures.

Here’s a look at the main types of spinal decompression procedures:

• Facetectomy: The neurosurgeon removes a facet joint located between a pair of vertebral bodies. “Each vertebral segment typically has two facet joints,” McNamara explained.

• Foraminotomy: The neurosurgeon removes bone to make the intervertebral foramen larger. The intervertebral foramen is “the passageway through which spinal nerves exit the spinal canal,” she said.

• Hemilaminectomy: The neurosurgeon removes part of a vertebral lamina. This surgery is often needed to access or decompress the spinal canal’s contents.

• Laminectomy: The neurosurgeon removes an entire vertebral lamina. If the surgical notes indicate the elimination of the posterior arch during surgery, then a laminectomy likely occurred.

• Laminotomy: The neurosurgeon removes a section of the vertebral lamina. Surgeons often perform a laminotomy to enlarge the intervertebral foramen, which can reduce pressure on a spinal nerve root.

Chris Boucher, MS, CPC, Senior Development Editor, AAPC