confused on laminectomy codes

[JenReyn99]

I'm confused because in some cases it looks to me like I should be using only the 63001-63005, which is Laminectomy with decompression without facetectomy, foraminotomy, or discectomy. But it seems that most people are using the 63045-63048 codes, which would include facetectomy and foraminotomy. So my question is, if the facetectomy, and foraminotomy are not clearly delineated in the op report, are you supposed to use that code? There's probably something I'm missing, so any help would be greatly appreciated! I could also use guidance on when to use 63020 and 63040 codes. I feel like I always do when I start some new specialtyverwhelmed, and lost. Any help is appreciated! thank you!

 

[malissagiles]

If the patient has central canal stenosis with no lateral or nerve root stenosis then the only part of the spinal cord that needs to be decompressed is the canal by removing the lamina (63001-63017). Since there is no associated stenosis in the facets or foramens then it wouldn't be necessary to decompress the nerve roots via a facetectomy or foraminotomy. This procedure isn't done much anymore since technology allows a lot less bone be removed in a decompression.

63045-63048 are used when the patient has lateral recess stenosis and the nerve roots need to be decompressed by doing a facetectomy and/or foraminotomy. The AMA needs to update these codes because again, due to advancements in technology a laminectomy plus a foraminotomy plus a facetectomy isn't always necessary to gain appropriate decompression.

63020 is for the INITIAL excision of a herniated disk (posterior approach).
63040 is for an excision of a recurrent herniated disk (posterior approach), if the redo is performed after 90 days of the initial excision. The extra RVU's associated with 63040 take into account the scar tissue that build up over time after the initial surgery.

 

[JenReyn99]

This is great info! Thanks for the help.