What is Correct CPT for Laminectomy with Foraminotomy

amandamkcj

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Hello! When a Laminectomy is performed with Foraminotomy (NO Facetectomy is done) I am having a difficult time determining the correct CPT code. CPT 63047 implies that all 3 Laminectomy, Foraminotomy AND Facetectomy must all be performed in order to capture so I don't feel I can use this CPT code (though this is normally the code the physician is requesting). CPT 63005 is only for Laminectomy without foraminotomy or facetectomy so again do not feel this is the appropriate code.

I have seen documented articles that also lead additional questions for example: Procedure Coding Made Simple By Kim Pollock printed in AAPC mag under # 1 "But decompression of the spinal canal can be coded per vertebral segment (63001-63017), or per level of foraminotomy (e.g., decompression of the L4 exiting nerve root via partial laminectomy at L4 and partial laminectomy at L5, with foraminotomy at L4-L5, is reported using one code: 63047). I don't get this...why would that be reported as 63047 when Facetectomy was not performed??? I must be missing something?

Is anyone able to assist with this question?

One of my specific reports:
Pre/Post Diagnosis: L3-5 Spondylosis
Procedure: L3-5 Laminectomy and bilateral foraminotomies
Laminectomy performed at L3 proceeded to also perform bilateral L3/4 foraminotomies ensuring adequate decompression. We proceeded to take down the scar over the L4 vertebral body level that partially consisted bilaterally of overgrown synovium. The scar was teased off. We proceeded to perform bilateral L4/5 laminectomy with foraminotomies using rongeours, ensuring adequeate decompression out the recess. Once decompression was achieved we proceeded to close.

I greatly appreciate any and all clarification to clear up this confusion.
 
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You would use the CPT that is most appropriate for the surgery that was performed. 63047 is most appropriate being that he did a laminectomy, foraminotomy for decompression. (it's ok that he didn't do facetectomies) Using 63017 implies that only a laminectomy was performed which would be incorrect because the physician did foraminotomy. I hope this helps some! :)
 

CoderinJax

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maybe a reduced services modifier?

I think 63047 is the closer of the 2 codes you listed, but I feel like the 52 modifier should be applied to that line to indicate that it was reduced due to not performing all 3 components.
 
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