Orthopedic Coding Alert

Question: My surgeon argues that we should be able to report a laminectomy (63047) in addition to a PLIF (22630), but our payer consistently rejects this. What's the appropriate coding for this situation?

New York Subscriber

Answer: This is a common and recurring question, and in fact, your surgeon is correct. You may report a separate laminectomy with posterior lumbar interbody fusion (PLIF, 22630, Arthrodesis, posterior interbody technique, including laminectomy and/or discectomy to prepare interspace [other than for decompression], single interspace; lumbar) -- or at least you may under certain circumstances.

Specifically, you are correct to report 63047 (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; lumbar) separately when "in addition to removing the disc and preparing the vertebral endplate, the surgeon removes posterior osteophytes and decompresses the spinal cord or nerve root(s), which requires work in excess of that normally performed when doing a posterior lumbar interbody fusion," according to the January 2001 CPT Assistant, published by the AMA.

You will have to append modifier 59 (Distinct procedural service) to 63047 to overcome the national Correct Coding Initiative (CCI) edit bundling 63047 to 22630. This assumes, of course, that the laminectomy is, indeed, of the extensive nature described by the CPT Assistant article quoted above.

Documentation is your primary weapon to prove that the laminectomy deserves separate payment (and to justify your modifier 59 use to unbundle the laminectomy from the PLIF). Remember that PLIF includes laminectomy, facetectomy and discectomy required to approach and prepare the interspace for arthrodesis. Therefore, the op report should state explicitly that the surgeon performed additional laminectomy specifically to "decompress the spinal canal and/or any nerve roots," and not just as an incidental or concurrent step to approach the disc and prepare the spine for fusion.

Information should be available stating what the surgeon decompressed, which laminae were removed, whether the surgeon performed foraminotomy and/or facetectomy, and which nerve roots he decompressed.

A separate diagnosis to justify the laminectomy, when available, helps, too.