dimplez
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As I understand CPT codes 63047/63048 are reported per vertebral segment with CPT stating that a vertebral segment describes the basic constituent part into which the spine may be divided. It represents a single complete vertebral bone with its associated articular processes and laminae. When providing this information to the coder, their response was "Laminectomies are coded by interspace or "level", not the individual vertebral body. L3-4 is coded 63047, L4-5 is coded 63048. See advice in AMA CPT assistant March 2022 SPINAL PROCEDURE UPDATES: "Reporting code 63048 along with parent code 63047 to represent work performed on only one segment (L1-L2) would constitute an overstatement of the work performed."
In reviewing the provided CPT Assistant (March 2022), I understand it to represent laminectomies AND fusion performed at the same level which is a misinterpretation of the intent of the statement she provided in rebuttal. Below is an operative report example where 63047 and 63048 were reported. Shouldn't it be 63047 and 63048 x2 or am I misunderstanding and advising incorrectly? Can someone please confirm??
Operative note:
patient was taken to the operating room and after induction of satisfactory endotracheal anesthesia, he was placed on the operating room table in the prone position on a Wilson frame and regular table. The lower back region was prepped and draped in a sterile fashion. A linear midline incision was made from the bottom of the spinous process of L2 down to the bottom of L5. The incision was carried down to and through the lumbodorsal fascia, following which the muscles were dissected in the subperiosteal plane to expose the lamina of L3, L4 and L5. Self-retaining retractors were added to maintain visualization. Fluoroscopy was used to confirm that we were at the appropriate levels. The spinous processes of L3, L4 and L5 were removed with a Leksell rongeur. The lateral edges of the lamina were identified at each level and then drilled through, using the drill until ligamentum flavum was encountered. We then elevated in successive fashion the L3, L4 and the L5 lamina away from the ligamentum flavum using the high-speed drill and Kerrison punches. The Kerrisons were then used to remove the remaining ligamentum flavum from the L3, L4 and L5 sublaminar space. The lateral recesses were inspected and freed up from their attachments to the dura with an angled curette. A large Kerrison punch was then used to open up the lateral recesses at L3-L4 and L4-5 by performing a medial facetectomy. The spinal canal was now very well decompressed. Hemostasis was accomplished with Surgifoam and bone wax along bony edges that were bleeding. The retractors were removed from the field and any bleeding points in the muscle coagulated. A medium size drain was left and sutured to the skin at its exit site. The deep muscle and fascia was closed with 0-Vicryl suture.
In reviewing the provided CPT Assistant (March 2022), I understand it to represent laminectomies AND fusion performed at the same level which is a misinterpretation of the intent of the statement she provided in rebuttal. Below is an operative report example where 63047 and 63048 were reported. Shouldn't it be 63047 and 63048 x2 or am I misunderstanding and advising incorrectly? Can someone please confirm??
Operative note:
patient was taken to the operating room and after induction of satisfactory endotracheal anesthesia, he was placed on the operating room table in the prone position on a Wilson frame and regular table. The lower back region was prepped and draped in a sterile fashion. A linear midline incision was made from the bottom of the spinous process of L2 down to the bottom of L5. The incision was carried down to and through the lumbodorsal fascia, following which the muscles were dissected in the subperiosteal plane to expose the lamina of L3, L4 and L5. Self-retaining retractors were added to maintain visualization. Fluoroscopy was used to confirm that we were at the appropriate levels. The spinous processes of L3, L4 and L5 were removed with a Leksell rongeur. The lateral edges of the lamina were identified at each level and then drilled through, using the drill until ligamentum flavum was encountered. We then elevated in successive fashion the L3, L4 and the L5 lamina away from the ligamentum flavum using the high-speed drill and Kerrison punches. The Kerrisons were then used to remove the remaining ligamentum flavum from the L3, L4 and L5 sublaminar space. The lateral recesses were inspected and freed up from their attachments to the dura with an angled curette. A large Kerrison punch was then used to open up the lateral recesses at L3-L4 and L4-5 by performing a medial facetectomy. The spinal canal was now very well decompressed. Hemostasis was accomplished with Surgifoam and bone wax along bony edges that were bleeding. The retractors were removed from the field and any bleeding points in the muscle coagulated. A medium size drain was left and sutured to the skin at its exit site. The deep muscle and fascia was closed with 0-Vicryl suture.