Orthopedic Coding Alert

Laminectomy, laminotomy, and laminoplasty: What’s the difference?

Spinal decompressions can get dicey when it comes time to code, particularly if you don’t know the different types of decompressions your surgeon might perform.

You can battle back against this potential confusion by launching a preemptive strike; be sure you know the different types of spinal decompressions inside and out before the next claims comes across your desk.

During her HEALTHCON 2020 presentation “Spinal Surgery Update 2020,” Lynn M. Anderanin, CPC, CPPM, CPC-I, CPMA, COSC, showed attendees just how specific decompressions can be by delving into how this broad surgical procedure is divvied up into many different codes due to surgical specifics, areas of the spine affected, etc. Check out what she had to say about some of the spinal decompression patients your surgeon might treat.

Decompression Splits Into Separate Services

One of the more common spinal procedure most practices will see is a decompression. When looking at encounter notes, they “should indicate that the provider is decompressing a nerve or spinal cord,” says Anderanin, who is senior director of coding education at Healthcare Information Services in Park Ridge, Illinois. If this is reflected in the notes, you’ve likely got a decompression claim on your hands.

Decompression procedures your practice might perform include: laminotomy, laminectomy, and laminoplasty. Read on for a breakdown of each surgical services, and which codes to use for each.

Laminectomy Focuses on Spinal ‘Arch’

When your surgeon performs a laminectomy, you’ll select a code from 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 63017 (Laminectomy with exploration and/or decompression of spinal cord and/or cauda equina, without facetectomy, foraminotomy or discectomy (eg, spinal stenosis), more than 2 vertebral segments; lumbar); or 63045 (Laminectomy, facetectomy and foraminotomy (unilateral or bilateral with decompression of spinal cord, cauda equina and/or nerve root[s], [eg, spinal or lateral recess stenosis]), single vertebral segment; cervical) through +63048 (Laminectomy, facetectomy and foraminotomy (unilateral or bilateral with decompression of spinal cord, cauda equina and/or nerve root[s], [eg, spinal or lateral recess stenosis]), single vertebral segment; each additional segment, cervical, thoracic, or lumbar (List separately in addition to code for primary procedure)).

During a 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 the nerves,” according to Codify.

Consider this laminectomy example from Toni Elhoms, CCS, CRC, CPC, AHIMA-Approved ICD-10-CM/PCS Trainer, chief executive officer of Alpha Coding Experts, LLC, in the Orlando, Florida area:

CC: Lumbar stenosis without neurogenic claudication

Physician actions: Decompressive laminectomy L4-S1

The patient is face down. The physician makes a midline incision overlying the affected vertebrae. Fascia is incised. Paravertebral muscles are retracted. The physician removes the spinous processes with rongeurs. If the stenosis is central, the physician removes the lamina out to the articular facets using a burr. If the compression is in the lateral recess, only half of the lamina is removed. A Penfield elevator peels the ligamentum flavum away from the dura. Nerve root canals are freed by additional resection of the facet, and compression is relieved by removal of any bony or tissue overgrowth around the foramen. Removal of the lamina, facets, and bony tissue or overgrowths may be performed bilaterally when indicated. The rongeur, retractor, and microscope are removed. A free-fat graft may be placed over the nerve root(s) for protection. If the ligamentum flavum was spared, it is placed over the free-fat graft. Paravertebral muscles are repositioned and the deeper tissues and skin are closed with layered sutures.

Coding: For this encounter, you’ll report 63047 (… lumbar) and +63048 with M48.061 (Spinal stenosis, lumbar region without neurogenic claudication) appended to represent the patient’s condition, Elhoms says.

Hemilaminectomy Might Be a Laminotomy

When your surgeon performs a laminotomy, you’ll choose a code from 63020 (Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disc; 1 interspace, cervical) through +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)).

A laminotomy, also known as hemilaminectomy or a partial laminectomy, “involves removing the upper and lower portions of adjacent laminae (that is, the laminae on either side of a vertebral interspace), rather than removing the entire lamina(ae) of a single vertebra,” according to Codify.

Consider this example, also from Elhoms:

CC: Herniated disc L4-L5 with radiculopathy

Physician actions: Lumbar microdiscectomy L4-L5 bilateral

The physician makes a midline incision is made through a posterior (back) approach overlying the vertebrae. The incision is carried down through the tissue to the paravertebral muscles, which are retracted. The ligamentum flavum, which attaches the lamina from one vertebra to the lamina of another, may be partially or completely removed. Part of the lamina is removed on one side to allow access to the spinal cord. If a disc has ruptured, fragments or the part of the disc compressing the nerves are removed. A partial removal of a facet (facetectomy) or removal of bone around the foramen (foraminotomy) may also be performed to relieve pressure on the nerve. When decompression is complete, a free-fat graft may be placed to protect the nerve root. If the ligamentum flavum was not removed, it is placed over the fat graft. Paravertebral muscles are repositioned and the tissue is closed in layers.

Coding: For this encounter, you’d report 63030 (Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disc; 1 interspace, lumbar), likely with either modifier 50 (Bilateral Procedure) or modifiers LT (Left Side) and RT (Right Side), depending on the payer. Also, append M51.16 (Intervertebral disc disorders with radiculopathy, lumbar region) to 63030 to represent the patient’s condition.

Remember that laminectomies involve a minimum of 50 percent of the lamina, and are often performed to treat stenosis patients. Conversely, laminotomies involve less than 50 percent of the lamina and are performed to treat disc disorders.

Look for Removed Vertebrae Tips on Laminoplasty

When your surgeon performs a laminoplasty, you’ll report 63050 (Laminoplasty, cervical, with decompression of the spinal cord, 2 or more vertebral segments) and/or 63051 (Laminoplasty, cervical, with decompression of the spinal cord, 2 or more vertebral segments; with reconstruction of the posterior bony elements (including the application of bridging bone graft and non-segmental fixation devices [eg, wire, suture, mini-plates], when performed)).

During a laminoplasty, “the physician makes an incision into the skin of the back of the neck. A groove is created in one side of the cervical vertebrae. The other side of the vertebrae is then cut all the way through. Then the physician removes the tips of the vertebrae,” according to Codify. Then, the surgeon opens the back of each vertebrae, taking pressure off of the spinal cord and nerve root.