adunlap23
Guru
Scenario:
A patient with history of L5-6 diskectomy has returned for the following problems/procedures:
Diagnosis: Spinal stenosis in the lumbar region with neurogenic claudication
Procedures: Reexploration posterior lumbar bilateral hemilaminectomies, medial facetectomies and foraminotomies at L2-3, L3-4, L4-5, and L5-6.
My understanding is, 63042 is for a "redo diskectomy" and is very diagnosis driven. In this case, the patient does have a history of diskectomy at L5-6, but no new diskectomy is being performed. This information, combined with the stenosis diagnosis, leads me to believe this should be coded as 63047, 63048 x3. However, the provider has chosen 63042 as the primary code.
I have reviewed prior discussions comparing 63042 and 63047, but I am looking for reputable sources or guidance that clearly support when 63042 is appropriate versus when 63047 should be used, particularly in re-exploration cases.
A patient with history of L5-6 diskectomy has returned for the following problems/procedures:
Diagnosis: Spinal stenosis in the lumbar region with neurogenic claudication
Procedures: Reexploration posterior lumbar bilateral hemilaminectomies, medial facetectomies and foraminotomies at L2-3, L3-4, L4-5, and L5-6.
My understanding is, 63042 is for a "redo diskectomy" and is very diagnosis driven. In this case, the patient does have a history of diskectomy at L5-6, but no new diskectomy is being performed. This information, combined with the stenosis diagnosis, leads me to believe this should be coded as 63047, 63048 x3. However, the provider has chosen 63042 as the primary code.
I have reviewed prior discussions comparing 63042 and 63047, but I am looking for reputable sources or guidance that clearly support when 63042 is appropriate versus when 63047 should be used, particularly in re-exploration cases.