Neurosurgery Coding Alert

Question: I’m new to neurosurgery coding, and I’m confused about how to correctly report the primary laminotomy CPT^® codes. Can you please help me?

New York Subscriber

Answer: CPT^® identifies four primary codes to describe laminotomy for the primary purpose of discectomy, which is an excision, in part or whole, of an intervertebral disc. These are all unilateral procedure codes to which modifier 50 (Bilateral procedure) may be applied when performed bilaterally at the same interspace level.

When you are reporting an excision of a herniated intervertebral disc, you would choose either 63020 (Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disc; 1 interspace, cervical) or 63030 (Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disc; 1 interspace, lumbar) as the primary laminotomy code, depending upon whether the neurosurgeon performed the procedure in the cervical or lumbar region.

For a re-exploration, you should report the following codes:

• 63040 (Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disc, reexploration, single interspace; cervical)
• 63042 (… lumbar).

There are also additional level codes applicable to these primary codes. You can report +63035 (Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disc; each additional interspace, cervical or lumbar (List separately in addition to code for primary procedure)) for each additional level of laminotomy after you have reported either 63020 or +63035. Code +63043 (Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disc, reexploration, single interspace; each additional cervical interspace (List separately in addition to code for primary procedure)) describes an additional level re-exploration cervical laminotomy, and code +63044 (Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disc, reexploration, single interspace; each additional lumbar interspace (List separately in addition to code for primary procedure)) describes an additional level reexploration lumbar laminotomy.