Wiki 63030 vs. 63047

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ms.coderll

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Can someone please explain to me in the simplest terms what the difference between 63030 and 63047 is? I know easier said than done. I am having a issue trying to code a case because I can not find the distinct differences between the two codes. Patients dx is Herniated Nucleus Pulposus and Lateral Recess Stenosis. Surgery performed is Left L4-L5 Hemilaminectomy and discectomy and placement of epidural fat graft.

A new coding company we are out sourcing these cases to coded 63030 and 63710.

The doctor coded 63047, 63048 and 15770. Now I have to explain who is correct ugh.

I am so confused Thanks
 
ms.coderll said:
Can someone please explain to me in the simplest terms what the difference between 63030 and 63047 is? I know easier said than done. I am having a issue trying to code a case because I can not find the distinct differences between the two codes. Patients dx is Herniated Nucleus Pulposus and Lateral Recess Stenosis. Surgery performed is Left L4-L5 Hemilaminectomy and discectomy and placement of epidural fat graft.

A new coding company we are out sourcing these cases to coded 63030 and 63710.

The doctor coded 63047, 63048 and 15770. Now I have to explain who is correct ugh.

I am so confused Thanks
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Based on my understanding of how these codes read in the CPT book, and the corresponding procedure descriptions in the Coders Desk Reference, 63030 would apply to a "vertebral interspace" while 63047 would apply to a "vertebral segment". Description of CPT 63047 does not reflect any disc removal.
Without a copy of your Operative report available for review, but based on the way your procedure is worded above.....it appears as though one "interspace" was addressed and a dural fat graft (CPT 63710) was performed. I would say that your outsourcing company is correct. CPT 15770 is definitely incorrect (that code is from the Integumentary System Section and would not be used in this scenario)
 
You are welcome.

I forgot to mention that Medicare and Medicaid consider CPT 63710 an
"Inpatient Only" procedure.
And depending on the circumstance (as noted in CPT Assistant below), the dura
graft may be included with CPT 63030:

To further clarify usage, code 63030 may be reported only when an open surgical technique (not an endoscopic approach/technique) is used and the intrinsic essential components of this code are performed; namely, a resection of the vertebral component, spinous processes, and lamina, which must include a discectomy, for decompression of the nerve root(s), as well as any laminotomy or laminectomy foraminotomy along with partial facetectomy, as needed for decompression of the nerves or required as part of the surgical approach. The repair of small intraoperative dural laceration or leak, and harvesting and placement of soft tissue graft, muscle, or fat when obtained from within the primary surgical incision, are considered part of the intraservice work and are not reported separately. If laminotomy with decompression of nerve root(s) is not performed, then it would not be appropriate to report code 63030 for the excision of the herniated intervertebral disc. However, code 63030 may be reported for an open procedure involving the use of a tubular retractor and endoscopic illumination and visualization rather than microscopic illumination and visualization.
 
63030

Can anyone tell me the payment on this cpt code if used with modifier 59? or Modifier 50? thanks
 
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