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Thread: Spinal surgery physician/coder disagreement

  1. #1

    Default Spinal surgery physician/coder disagreement

    AAPC: Back to School
    This is the question we asked physician:
    The L4-L5 disk was incised and L4-L5 disk was removed and sent to pathology. At the L5-S1 level you indicate that a large extruded disk fragment was identified at that level and removed and sent to pathology. I would bill-63030 and 63035. Please help me out. If disk material was remove at both levels, I do not see where 63047 and 63030 would be correct. Even though the primary dx for L4-L5 is stenosis, disc was removed.
    Let me know what you think.

    Please give us your opinion on which codes should be billed - physician want 63047 and 63030 billed b/c stenosis is primary diagnosis ---we believe it should be 63030 and 63035 b/c disk was ultimately removed. The following is the physican response.

    "I strongly disagree. The primary pathology at the other level (L4-5) was stenosis, and the primary surgical treatment was that of treatment of stenosis. The correct surgical code should be the one that most accurately describes the work performed, not necessarily one small aspect of the procedure performed. The procedure performed at L4-5, regardless of whether any disc was taken out or not, was a decompression for spinal stenosis, as is reflected in the operative note"

  2. #2


    Was there any other work done @ the L4/5 interspace (facetectomy, foraminotomy, laminectomy)? If so then your surgeon is correct the disc removal would be inclusive to 63047. If your surgeon only did Hemilami, partial facetectomy then you are correct to code 63030.

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