Wiki 63047 or 63030

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pinnaclephyserv

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I am struggling this morning. I am leaning more towards 63047.

Narrative: The patient was brought into the operating room. He successfully underwent endotracheal intubation administration general anesthesia. Patient was then carefully positioned prone on the radiolucent table. The area of the patient's lower back was then prepped and draped in the usual sterile manner. Fluoroscopy was brought in. Fluoroscopy assisted with skin incision placement. Skin incision made was made 2 fingerbreadths from midline and on the right side. Fascia was divided with electrocautery. Tubular retractor was placed following serial dilation and docked onto the lamina of L5 4 on the right. Fluoroscopy confirmed our location. Microscopic light source was brought in for direct visualization. Residual soft tissue was carefully removed with electrocautery. Laminectomy facetectomy and foraminotomy were begun with the fluted bur and completed with the diamond bur as well as straight and angled curettes and Kerrison Rogers. Decompression of also included the exiting and transversing L4 and L5 nerve roots. Disc herniation was identified displacing the right L5 nerve root. The nerve root was carefully mobilized towards the midline. Small and annulotomy was made with a 15. Knife blade. Several pieces of disc material were removed with micro pituitary rongeur and reverse angle curettes. Following diskectomy decompression the thecal sac and that respective nerve roots were free and mobile. Hemostasis was well maintained throughout the operative procedure. Tubular retractor was removed. We then commenced with closure of the incision. This was done in the usual manner. A dry sterile dressing
 
pinnaclephyserv said:
I am struggling this morning. I am leaning more towards 63047.

Narrative: The patient was brought into the operating room. He successfully underwent endotracheal intubation administration general anesthesia. Patient was then carefully positioned prone on the radiolucent table. The area of the patient's lower back was then prepped and draped in the usual sterile manner. Fluoroscopy was brought in. Fluoroscopy assisted with skin incision placement. Skin incision made was made 2 fingerbreadths from midline and on the right side. Fascia was divided with electrocautery. Tubular retractor was placed following serial dilation and docked onto the lamina of L5 4 on the right. Fluoroscopy confirmed our location. Microscopic light source was brought in for direct visualization. Residual soft tissue was carefully removed with electrocautery. Laminectomy facetectomy and foraminotomy were begun with the fluted bur and completed with the diamond bur as well as straight and angled curettes and Kerrison Rogers. Decompression of also included the exiting and transversing L4 and L5 nerve roots. Disc herniation was identified displacing the right L5 nerve root. The nerve root was carefully mobilized towards the midline. Small and annulotomy was made with a 15. Knife blade. Several pieces of disc material were removed with micro pituitary rongeur and reverse angle curettes. Following diskectomy decompression the thecal sac and that respective nerve roots were free and mobile. Hemostasis was well maintained throughout the operative procedure. Tubular retractor was removed. We then commenced with closure of the incision. This was done in the usual manner. A dry sterile dressing
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These two codes are kind of DX code dependent. 63047 is more for stenosis. www.miramedgs.com/images/thecode/TheCodeJanuary2016.pdf
 
Agree with the advice above. It depends on the intent of the procedure. Was it done for a herniated disc or was it done for stenosis? Many times these two can occur at the same location and these can be difficult to decide between. This one sounds more like 63030. If you read the 63030 description, it contains "including partial facetectomy, foraminotomy" and includes "hemi-laminectomy". The 63047 is usually more for stenosis (bony) where 63030 is disc. The diganosis header can also help point you in the right direction. Also think about it like this, would they have brought the patient in for surgery if it was not for a disc herniation and associated symptoms? Were there any other procedures done during the same case?

Older link but explains the concept: Commonly Asked Coding Questions
Diskectomy and stenosis procedures
Q: The surgeon performed a laminectomy, facetectomy, foraminotomy, and decompression at L4-5 for a diagnosis of spinal stenosis. A laminectomy with diskectomy and decompression was also documented at L5-S1 for a diagnosis of protruded lumbar disk. Should the second-level surgery (L5-S1) be reported with the add-on code 63048? Or should a second primary code (63030) be reported for the diskectomy at L5-S1?

A: These procedure codes are directly related to the diagnosis. CPT code 63047 is reported for the surgery at L4-5 linked to the stenosis diagnosis. CPT code 63047 is a unilateral/bilateral code and is reported one time per lumbar level.

The surgery at L5-S1 is reported as 63030-59 to indicate a distinct procedure was performed at a different level and is linked to a disk diagnosis. CPT code 63030 is considered a unilateral procedure and may be reported bilaterally when the surgeon performs a right and left diskectomy. Do not confuse the coding of these procedures; they are diagnosis-driven CPT codes.
 
Am I correct on the coding? am I missing something

1. Posterior lumbar interbody fusion and posterolateral fusion L3-4. cpt 22633
2. Lumbar laminectomy with facetectomy and foraminotomy and excision of large herniated disc, L3-4 left. 63030 cpt
3. Placement of interbody cage to lumber interspace at L3-4.
4. Placement of nonsegmental pedicle screw rod fixation L3-4. Bundled
5. Exploration of spinal fusion L4-S1. Bundled
6. Harvesting morselized iliac crest bone graft through separate skin and fascial is incision left. Bundled
7. Use of allograft bone graft. 8. Use of operative microscope the scopic light source. Bundled
 
Based on the information provided, if 63030 was performed at L3-L4 it's considered inclusive to 22633 and it shouldn't be reported separately.
Since there was an interbody fusion you should report 22853 for the cage.
If the body of the note supports rods as the nonsegmental instrumentation it should be reported with 22840
If no procedure other than the spinal fusion exploration was performed at L4-S1, the exploration can be reported with 22830 and modifier 59
I would also report the harvesting of morselized iliac crest bone with CPT 20937 as this is not bundled.
 
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