AAPC - Back to school
Results 1 to 4 of 4

Thread: Laminectomy w/removal of intraspinal lesion

  1. #1

    Default Laminectomy w/removal of intraspinal lesion

    AAPC: Back to School
    I'd appreciate some input on the following surgery:

    "Patient was placed in a prone in a Wilson frame which has distracted the maximal kyphosis. All pressure points were well padded. A temporary skin prep was made and a spinal needle was inserted near the L4-L5 interspace and then needle localization by flouroscopy was performed. This helped in placing surgical incision. Next, the needle was removed and the lumbar spine was prepped and draped in the usual sterile fashion, and based on the preoperative fluoroscopic image, about a 1-inch incision was made over the L4 and L5 interspace in the midline. Bovie cautery was used to incise the dermis and subdermal fat and incise the lumbodorsal fascia along the spinous processes of the L4 and L5. A Cottle elevator subperiosteally dissected the paravertebral muscles off the L4 and L5 lamina. A self-retaining retractor was placed. Another intraoperative flouroscopic image was taken with the needle underneath the L4 lamina. This confirmed the surgica level. Next, a microscope resector was brought in and a high-speed bur was used to perform a partial laminectomy removing the distal portion of L4 and proximal portion of L5 lamina. THis laminectomy was enlarged with a Kerrison ronguer. THe ligamentum flavum was then elevated and removed. This revealed the thecal sac traversing L5 nerve root. In attempts to retract the nerve root to the midline there was noted to be abundant adherance, therefore a neurlysis wa performed. This allowed the neural structures to be retracted to the midline which revealed a large intraspinal lesion. This was removed with a combination of curette ball-tip probes and pituitary rongeurs. Next the disc space at L4-L5 was visualized and found to have an annular bulge. Therfore, an annulotomy was performed and the disc material was removed with the Kerrision rongeur and angled curettes. The disc space was then irrigated with a pressurized salline to remove any remaining loose fragments. Once this was confirmed that there was no residual disc material that was loose, a second look around the decompression site was made to ensure that there were no missed fragments. Once the decompression was done, there was no residual central or lateral recess or framinal stenosis and the nerve roots at L5 were free." The bleeding was stopped, fascia closed, etc.

    I'm looking at 63267, but it seems to me that something more can be coded here such as 63030. Any help would be appreciated.

  2. #2


    63030 bundles. You cannot use mod 59 since it is involving the same disc as the lesion. Your code is correct. If the lesion was on any disc but L4 or L5, you can get away with a modifier 59.

  3. #3
    Join Date
    Apr 2007
    North Carolina


    You present an interesting scenerio. At first I thought no but I'm wavering a little now. 63267=excision by laminectomy of lesion other than herniated disc

    Your op note states......

    "Next the disc space at L4-L5 was visualized and found to have an annular bulge. Therfore, an annulotomy was performed and the disc material was removed with the Kerrision rongeur and angled curettes"

    My thought was that the annulotomy was over and beyond 63267. So...I asked my Neuro PA and he seemed to think it was feasible, also. He did seem to think you would have to submit the op note for medical review. I know that CCI edits bundle the two together; however, our provider thought it was worth a try since he understands the work that is involved.

  4. #4


    Thank you for your responses. It's always appreciated.

Similar Threads

  1. Intraspinal Cord injection under microscope
    By maryir in forum General Surgery
    Replies: 0
    Last Post: 10-07-2011, 11:38 AM
  2. Decompressive laminectomy with removal of synovial cyst
    By Melody Morland CPC in forum Orthopaedics
    Replies: 4
    Last Post: 03-23-2011, 10:12 AM
  3. Laminectomy and removal of The coperitoneal shunt
    By Tomeka in forum Medical Coding General Discussion
    Replies: 0
    Last Post: 06-21-2010, 10:45 AM
  4. Lesion Removal
    By lori85210 in forum Orthopaedics
    Replies: 1
    Last Post: 06-10-2009, 11:21 AM
  5. Removal of cyst during Laminectomy
    By TAMMYS in forum Medical Coding General Discussion
    Replies: 1
    Last Post: 09-23-2008, 10:43 AM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts

Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?


Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.