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Need opinion on 63030

  1. Default Need opinion on 63030
    Medical Coding Books
    Does this op note warrant a 63030?

    Decompressive laminectomy and decompressive bilateral foraminotomies were performed by doing subtotal facetectomies at L4-5 and L5-S1 bilaterally removing bone material. There was extensive facet arthrosis and hypertrophy. The bone was carefully cleaned of all soft tissue and morselized and used as bone graft material. Not much in the way of central canal stenosis. There was significant foraminal stenosis of both levels. Foraminotomies were performed by following each of the nerve roots out onto their corresponding neuroforamina on order to ensure complete decompression of that nerve root.

    Next, annulotomies were performed on both sides at both levels carefully retracting neural elements to the midline. There was a large disk herniation on the left side at L4-5 which was subligamentous and also had free fragment components. That disk herniation was successfully removed. A large amount of disk material was removed from the epidural and subligamentous space. The remainder of the epidural space was explored and no further free fragments disk were found. The disk spaces were then prepared for interbody spacers.

    Doc also performed interbody and posterolateral fusions. Insurance carrier is taking back $$ for 63030 saying that the clinical documentation does not support this code. Any opinions would be appreciated. Thanks
    Ann Marie CPC
    New Britain, CT

  2. #2
    Location
    North Carolina
    Posts
    3,126
    Default
    Personally, I think you have 63030 supported with this statement....

    Decompressive laminectomy and decompressive bilateral foraminotomies were performed by doing subtotal facetectomies at L4-5 and L5-S1 bilaterally removing bone material. There was extensive facet arthrosis and hypertrophy. The bone was carefully cleaned of all soft tissue and morselized and used as bone graft material. Not much in the way of central canal stenosis. There was significant foraminal stenosis of both levels. Foraminotomies were performed by following each of the nerve roots out onto their corresponding neuroforamina on order to ensure complete decompression of that nerve root

    63030/63047 can be reported when the surgeon removes posterior osteophytes and decompresses the spinal cord/ nerve roots, which requires work in excess of that normally performed when doing a posterior lumbar interbody fusion.

    Have you requested a second review? May I ask what carrier?

  3. #3
    Location
    Columbia, MO
    Posts
    12,527
    Default
    May we ask what other codes did you bill on this claim?

  4. Default
    Carrier is Anthem BCBS. Surgery was billed as:

    22612
    22614
    22630-51
    63030-59
    63047-59
    63048-59
    63048-59
    22842
    22851
    22851
    20936
    76001
    Ann Marie CPC
    New Britain, CT

  5. #5
    Location
    North Carolina
    Posts
    3,126
    Default
    Your problem may be 63030 and 63047 billed together........

  6. Default
    Thank you Rebecca
    Ann Marie CPC
    New Britain, CT

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