Neurosurgery Coding Alert

Question: How can we bill a cervical laminoplasty C3-C7 with synovial cyst removal at C3-C4?

Ohio Subscriber

Answer: There are two CPT^® codes that you can report for cervical laminoplasty:

63050 -- Laminoplasty, cervical, with decompression of the spinal cord, two or more vertebral segments

63051 … with reconstruction of the posterior bony elements (including the application of bridging bone graft and non-segmental fixation devices [e.g., wire, suture, mini-plates], when performed).

Codes 63050 and 63051 describe laminoplasty on two or more spinal levels. Therefore, you would report laminoplasty of two levels or of five levels using a single code. If the surgeon performs the laminoplasty on a single level, you would report a cervical laminectomy code 63045, as laminoplasty requires treatment of at least two levels.

Note also that 63050 and 63051 include arthrodesis, instrumentation, laminectomy and/or laminotomy, and spinal reconstruction as described by 22600, 22614, 22840-22842, 63001, 63015, 63045, 63048 and 63295. Therefore, you should not report any of these procedures separately with 63050 or 63051. Similarly, excision of a cervical synovial cyst would be considered incidental to laminoplasty and would not be separately reported.  In addition, 63051 includes bone graft placement to and application of instrumentation to fix and stabilize the spine.

What is cervical laminoplasty? Cervical laminoplasty is a technique in which your surgeon decompresses the spinal cord while retaining structural support for the vertebral column. You surgeon cuts through the lamina on one side of the spinous process at the affected level(s) and notches the lamina on the opposite sides to create a hinge on which to the posterior segment of the vertebrae can be opened and the spinal cord can be released. Your surgeon may then place bone grafts in the space left by the ‘open door’ which are secured with titanium plates to provide structural stability and anchor for muscles to reattach.