Help with back surgery

madgejones10

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Please help me with coding this back surgery (I am no good with backs!!).

Pre-operative: Lumbar stenosis, central and foraminal and lateral recess of L4-5, recurrent, and L5-S1.

Post-op Diagnosis: Same as pre-operative with addition of recurrent stenosis at L3-4.

Operative Procedure:
1. Lumbar laminectomy and decompression with central laminectomy.
2. Bilateral foraminotomies.
3. Bilateral partial medial facectomies, right and left at L3-4 recurrent. L4-5 recurrent and L5-S1 as well as central midline decompressions.

Description: Back was prepped and draped in routine sterile fashion and using lateral vision fluoroscopy, spinal needle advanced in the L5-S1interspace. Incision extended distally with dissection through the skin and subcutaneous tissues and fascia divided. We progressed inferiorly to soperiorly to obtain good, clean planes before moving into the scar tissue more proximally. Dissection facilitated around the spinous processes, over the lamina and decompression facilitated at each level which included midline laminectomies, partial medial facetectomies and foraminotomies at each level. Scar tissue was excised as well. The arthritic overgrowth from the fact joints was removed and excellent decompressions obtained at each level ......

It has been suggested 63042 59 63047 and 63044 but wanted another opinion in neurosurgery forum ... THANKS!
 

ckirkp1

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Me personally I would code 63047 with 63048x3 but that is just my opinion because 63042 is more for removal of herniated disk according to the dx pt has spinal stenosis. There is not really a code for reexploration of recurring stenosis so thats why I would go with 63047. If the doctor performed the same surgery prior to this surgery before the 90 day global was up then use modifer 78 but if its past the 90 day global don't worry about the modifier. But don't count me on this its best to ask your dr what he would suggest. Any other suggestions????
 

SJMarra

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I agree with not using 63042 - that is used for recurrent herniation. If pt has stenosis, use 63047 (L3-4) for the first level, then 63048 X 2 (L4-L5 and L5-S1).
 

ckirkp1

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codes 63047 is single vertebral segment and 63048 is for each additional vertebra segment; segment being the key word in the description so you would count each segment not levels. Levels would include 2 segmts but it states a single vert. seg. so you would count each segment. So it would be 63047 plus 63048x3 if you do decide to go with that code.
 
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penguins11

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63042 is the correct code, 63042 is for a redo. Please note that the description for cpt 63042 is "Laminotomy (hemilaminectomy), with decompression fo nerve root(s), including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disc..." With the descriptor and/or, it is appropriate to use 63042 for a redo, you are shorting your dr's reimbursement if you dont bill for a redo. 63042 provides additional reimbursement because there is more work involved in a redo. I would suggest 63042, 63047 and 63044. In addition, code 63047 is per vertebral segment but if the dr doesnt identify which nerve roots were decompressed, it is instructed in Neurosurgery coding courses to bill per interspace.
 

penguins11

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I checked back through my AANS notes and code 63047 is correct for stenosis, 63042 is only for redo discectomy. I would still only code 63047 and 63048 x 2 as the dr. did not indicate the specific nerve roots decompressed. He must document the specific nerve root decompressed in order to bill per segment. Glad this was posted!
 

camilleb

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I would code 63047, 63048 x 3 for the decompression at each level. Based on what is notated: and decompression facilitated at each level
It's amazing how we all differ from coder to coder.
 

madgejones10

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I cannot thank you all enough for weighing in on this. I AM SO GRATEFUL TO ALL OF YOU! I definitely learned alot from the above discussions! Isn't it great to have friends (fellow coders!) to call on! Thank you all !!!!!!:)
 
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