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Spine

  1. #1
    Location
    Greater Pittsburgh
    Posts
    390
    Default Spine
    Medical Coding Books
    Can someone explain the difference between 63005 and 63267, which would I use for the diagnosis of L3-L4 large facet cyst causing spinal stenosis?

    .....the Taylor retractor was placed lateral to the L3-L4 facet. Starting at the interval between the L3-L4 lamina, the ligamentum flavum was removed in piecemeal fashion using a 3MM Kerrison rongeur. The laminotomies and a hemilaminectomy of L3 were done. There was a large facet cyst that was pushing the thecal sac and it was removed the Kerrison rongeurs. We extended the hemilaminectomy above the facet cyst to get to normal dura above and below the facet cyst. We then checked the foramen at 3-4 and 4-5 with a Woodson. There was no neurologic compression, no ventral thecal sac compression, no disk herniation. Any epidural bleeding indentified and coagulated with bipolar cautery. Once the decompresssion was done, the dura was nice and free. The wound was irrigated and dired prior to closure........

    Thank you in advance for your assistance.
    jdemar, CPC, CMA

  2. #2
    Location
    North Carolina
    Posts
    3,126
    Default
    63005=The physician makes an incision in the skin to access the spinal column. The physician removes the gelatinous covering of the vertebrae and removes bone or other tissue that is compressing the spinal cord. The physician performs the procedure on one or two vertebrae in the lower back.

    63267=The physician removes the lamina from a vertebra in the lower back and removes a non-cancerous lesion from the spinal cord outside the dural sheath.


    It appears that 63267 is the better fit. It also looks like the cyst is outside the dura..."We extended the hemilaminectomy above the facet cyst to get to normal dura above and below the facet cyst"

  3. #3
    Location
    Greater Pittsburgh
    Posts
    390
    Default
    That's what I thought, then one of my nurses directed me to 22102 because it states 'intrinsic bony lesion'....your thoughts please and thanks again!
    jdemar, CPC, CMA

  4. #4
    Location
    North Carolina
    Posts
    3,126
    Default
    Personally, I would still go with 63267 since the physician is removing a cyst not to mention a lami was done. I associate 22102 with a bone spur...

    22102=The physician partially excises a bony lesion from a vertebral component (e.g., spinous process, lamina, or facet). The physician creates an incision over the vertebral segment containing the bony lesion (e.g., bone spur) and carries the incision through the paravertebral muscles and to the lesion. The physician excises the affected portion of the vertebral segment.

    IMHO...

  5. #5
    Location
    Greater Pittsburgh
    Posts
    390
    Default
    Thank you so much for your input, I agree.
    jdemar, CPC, CMA

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