63046 and 63047

ybarde

Contributor
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Hello Everyone,

I am working on Neurology surgeries and observed that my surgeon is doing laminectomy on thoracic and lumbar.

I am in confusion how to code this.

Should I code it 63046 for thoracic laminectomy and 63047 for lumbar laminectomy.

Or

Should I code 63046 and 63048 ?

Please help me.

May God bless you all!
 

cpc2007

Guru
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How this procedure is coded will depend on the exact levels of the spine addressed in the surgery. If the surgeon is working on contiguous spinal levels (e.g., thoracic decompression is at T12 and lumbar decompression at L1), you should report 63046 and 63048. If the levels are not contiguous and must be approached through separate incisions, you could support 63046 and 63047 together.

One of the guidelines that helped me to better understand coding this scenario is from the NCCI Policy Manual from Medicare in Chapter 8, section C.22 which says this:

Many spinal procedures are grouped into families of codes where there are separate primary procedure codes describing the procedure at a single vertebral level in the cervical, thoracic, or lumbar region of the spine. Within some families of codes there is an add-on code for reporting the same procedure at each additional level without specification of the spinal region for the add-on code. When multiple procedures from one of these families of codes are performed at contiguous vertebral levels, a physician shall report only one primary code within the family of codes for one level and shall report additional contiguous levels utilizing the add-on code(s) in the family of codes. The reported primary code should be the one corresponding to the spinal region of the first procedure. If multiple procedures from one of these families of codes are performed through separate skin incisions at multiple vertebral levels that are not contiguous and in different regions of the spine, the physician may report one primary code for each non-contiguous region.

I also noticed that you mentioned a "laminectomy" was performed in the thoracic and lumbar spine. CPT 63046/63047/63048 require a facetectomy and/or foraminotomy in addition to a laminectomy so I wanted to verify your documentation supports one or both of these additional procedures along with the laminectomy to support coding these CPT codes. Laminectomies for decompression alone without a facetectomy and/or foraminotomy would be coded with 63003 or 63016 for the thoracic spine and 63005 or 63017 for the lumbar spine (depending on the total number of segments decompressed with laminectomy).

I hope that helps - have a great night :)

Kim
www.codingmastery.com
 
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