Excision of extradural facet cyst

deickbush

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Please help with the following:

...a decompression was performed by starting at L5 working proximally with the removal of lamina at L4 and then the lamina of L3 and then the lamina of L2 working laterally with the removal of the inferior and superior facets bilaterally. At the L2L3 level on the right, an extradural facet cyst was seen and this was removed without difficulty. It, however was stuck to the underlying dura and a great deal of care had to be taken to remove this...

Can he code for the removal, or just the laminectomy. I am not sure whether to use 63267 or 63047, 63048x2. If I use 63267, I do not see a code for add'l segments. :confused:

Thanks!

Denise
 

LLynn29

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63267 can be used if the excision is more involved such as adherent to the dura however, there are no additional segment codes that can be reported with this code.
 

SJMarra

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If the surgery was to remove the cyst use the 63267 code, if the primary reason for the surgery was the laminectomy and the cyst removal was incidental, use 63047 and 63048 for each additional level
 
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