Wiki 63267 and 63047 Billed together?

[lxsullivan23]

Hi All,
Had a dr do a synovial csyt removal at L3-4, and then a lami at L4-5 for stenosis. It was coded as 63267 and 63047. Can these be billed together even with a mod 59?

Thanks

 

[jeslowery]

I believe they can be billed together since they are at separate levels. Per AAOS for CPT 63267 lami at same level is included in 63267.

63267:
"Intraoperative services included in the global service package:
• local infiltration of medication(s), anesthetic, or contrast agent before, during, or at the conclusion of the operation
• suture or staple removal by operating surgeon or designee
• surgical approach, with necessary identification, isolation, and protection of anatomic structures, including hemostasis and minor skin scar revision
• obtaining wound specimen(s) for culture
• wound irrigation
• intraoperative photo(s) and/or video recording, excluding ionizing radiation
• intraoperative supervision and positioning of imaging and/or monitoring equipment by operating surgeon or assistant(s)
• insertion, placement, and removal of surgical drain(s), re-infusion device(s), irrigation tube(s), or catheter(s)
• closure of wound and repair of tissues divided for initial surgical exposure, partial or complete
• application of initial dressing, orthosis, or continuous passive motion, except where specifically excluded from global package
• laminectomy at same level (eg, 63047)
• removal of posterior elements at same level (eg, 22102)

Intraoperative services not included in the global service package:
• conscious sedation, regional block(s), Bier block(s)
• supplies and medication (eg, code 99070, HCPCS Level II codes)
• insertion, removal, or exchange of nonbiodegradable drug delivery implants (eg, 11981—11983)
• harvesting of graft through separate skin or fascial excision, distant site
• arthrodesis (eg, 22554, 22585)
• instrumentation (eg, 22840, 22842, 22845, 22846) "

 

[jrclark1987@yahoo.com]

Please see attached Guidance. No you cannot for contiguous/ adjacent levels of resection. hope this helps

 

[jschmutz]

update CPT Assistant 2025

Question: A surgeon performs a laminectomy/facetectomy and foraminotomy on a patient whohas spinal stenosis of the lumbar spine at the L3-L4 level to decompress it. In addition, the patient also has a synovial cyst that is adherent to dura and is resected at the L4-L5 level. Would it be appropriate to report codes 63267 and 63047 with modifier 59 appended for the different spinal levels involved, or would it be appropriate to report only code 63267?

Answer: For this scenario, it would be appropriate to report code 63267, Laminectomy forexcision or evacuation of intraspinal lesion other than neoplasm, extradural; lumbar. It wouldalso be appropriate to report code 63047, Laminectomy, facetectomy and foraminotomy(unilateral or bilateral with decompression of spinal cord, cauda equina and/or nerve root,[eg, spinal or lateral recess stenosis]), single vertebral segment; lumbar, with modifier 59,Distinct Procedural Services, and modifier 51, Multiple Procedures. Based on the documentation provided, the physician performed these procedures to address different pathologies: spinalstenosis decompression at the L3-L4 level and a resection of a synovial cyst at the L4-L5 level.Report the appropriate International Classification of Diseases (ICD-10-CM) codes that identify spinal stenosis of the lumbar spine and synovial cyst of the lumbar spine, in conjunction withcodes 63267 and 63047 with modifier 59 to further support the different pathologies addressed in the procedure performed.