Wiki laminotomy/med facetectomy--recess stenosis

[kathymarks]

I am a payer with an op report documenting laminotomy and medial facetectomy along with ligmentum flavum removal on the right and left side of L4-L5 facet joint. L5 nerve root was widely decompressed on both sides. MRI report had documented the development of spinal stenosis in the lateral recesses on extension. Difference of opinion whether correct coding is 63030 or 63047. Can you clarify and give rationale? Thanks so much.

 

[penguins11]

Codes 63030 and 63047 are often determined by the diagnosis code. 63047 is a unilateral or bilateral code. In the example you gave below, I would code 63047 because it appears that it was done for decompression and for stenosis, not for removal of a herniated disc. If the dr did the procedure for removal of herniated disc and that was the main purpose of the procedure, I would code 63030. When deciding whether to use 63030 or 63047, I usually look at the diagnosis code and the intent behind originally doing the procedure.