L4-S1 segmental instrumentation Open posterior approach And the codes are 63030 – L3 laminectomy 22633 – comb post. w/ post. Interbody technique including laminectomy and/or discectomy, single interspace and segment; lumbar 22634 – each additional interspace
discectomy harvesting of bone graft And the codes are 0SG00AJ (L4-L5) and 0SG30AJ (L5-S1) for the transforaminal lumbar interbody fusion 0SG0071 (L4-L5) and 0SG3071 (L5-S1) posterior spinal fusion 0SB20ZZ and 0SB40ZZ discectomy at 2 levels 0QB20ZZ for harvesting of bone graft #5 Posterior Cervical Fusion and Instrumentation, C5-T1
Assign code 00JU0ZZ for laminectomy performed for the purpose of exploration or decompression of the spinal canal. Laminectomy performed for excision of herniated disc represents the operative approach and is not coded.
Our surgeon performed a L4-5 laminectomy, foraminotomies, neurolysis of nerve roots plus nmicrosurgical excision of bilateral synovial cyst. We billed as follows: The CPT 63267 is being denied for content of service to the 63047 and 63048.
2022 ICD-10-PCS Procedure Code 00NY0ZZ: Release Lumbar Spinal Cord, Open Approach.
The 2022 edition of ICD-10-CM M43. 26 became effective on October 1, 2021.
Other specified postprocedural states The 2022 edition of ICD-10-CM Z98. 89 became effective on October 1, 2021.
Postlaminectomy syndrome, not elsewhere classified M96. 1 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. The 2022 edition of ICD-10-CM M96. 1 became effective on October 1, 2021.
A lumbar laminectomy involves the removal of the lamina, the back portion of a spinal bone in the lower back. This creates more room within the spinal canal.
63005 Laminectomy with exploration and/or decompression of spinal cord and/or cauda equina, without facetectomy, foraminotomy or discectomy (e.g., spinal stenosis), 1 or 2 vertebral segments; lumbar, except for spondylolisthesis.
Laminectomy (removal of lamina bone) and diskectomy (removing damaged disk tissue) are both types of spinal decompression surgery. Your provider may perform a diskectomy or other techniques (such as joining two vertebrae, called spinal fusion) during a laminectomy procedure.
A laminectomy will include a fusion component if a patient has experienced slippage of the vertebrae or has a curvature of the spine. The surgeon will fuse the affected vertebrae using a bone graft.
If the spinal fusion was done during surgery then use the Z98. 1 code. If the patient has a natural fusion of the spine or (ankylosing spondylitis) which causes the spine to fuse then use the M43.
Strictly speaking, post-laminectomy syndrome means that a person is experiencing pain, and that they had a prior spinal surgery (not necessarily even a laminectomy). As such, there are many different forms that this condition can take.
Laminectomy (removal of lamina bone) and diskectomy (removing damaged disk tissue) are both types of spinal decompression surgery. Your provider may perform a diskectomy or other techniques (such as joining two vertebrae, called spinal fusion) during a laminectomy procedure.
A laminectomy will include a fusion component if a patient has experienced slippage of the vertebrae or has a curvature of the spine. The surgeon will fuse the affected vertebrae using a bone graft.
Laminectomy is the most common type of surgery done to treat lumbar (low back) spinal stenosis. This is also called decompression surgery. This surgery is done to relieve pressure on the spinal nerve roots caused by age-related changes in the spine.
06.
The codes for the anterior spinal fusion are 0SG00AJ (L4-L5) and 0SG30AJ (L5-S1) . Two codes are also assigned for the posterior spinal fusion, 0SG0071 (L4-L5) and 0SG3071 (L5-S1) . Codes 0SB20ZZ and 0SB40ZZ are also assigned for the discectomy performed at two different levels of the spine. Lastly, code 0QB20ZZ is assigned for the harvesting of the right iliac crest bone graft.
The implementation of ICD-10-PCS has enhanced the skills of coding professionals as it contains many unique features that provide an opportunity to accurately reflect the complexity of the procedures being performed. The assignment of ICD-9-CM procedure codes for spinal fusions often challenged coding professionals, and this has not changed with the transition to ICD-10-PCS. As with the coding of other complex surgical procedures, coding professionals struggle with identifying which portion of the spinal fusion procedure to code or not to code.
If an interbody fusion device is used (alone or containing other material like bone graft), the procedure is coded with the device value Interbody Fusion Device (A)
If the operative report documents that a discectomy is performed , the correct root operation is Excision. However, if the operative report documents a “total discectomy,” the root operation is Resection.
Qualifier: The qualifier character identifies the column of the spine being fused (anterior or posterior) and if the surgical approach is from the front or back of the body (see Figure 1 below).
As with Examples #1 and #2, the segmental instrumentation is included in the spinal fusion and is not coded separately. The lumbar decompression L4-L5 and L5-S1 bilateral foraminotomies and L3 decompression laminectomy are also considered to be integral to the spinal fusion and not coded separately.
Decompression is the general term to describe removal of the spinal disk, bone, or tissue causing pressure and pain. Often, this is the only procedure performed. Examples include: laminectomy to decompress spinal canal and/or nerve roots (e.g., 63001-63017, 63045-+63048), discectomy to decompress spinal canal and/or nerve roots (e.g., 63020-+63035, 63040-+63044, 63055-+63057), corpectomy (e.g., 63081-+63091), fracture repair (e.g., 22325-+22328), etc.#N#CPT® designates the decompression codes as being per “vertebral segment” or per “interspace.” Decompression occurs at the interspace for discectomy codes (e.g., right L4-L5 interspace). Discectomy is a single, standalone code, such as 63030 Laminotomy (hemilaminectomy), with decompression of nerve root (s), including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disc; 1 interspace, lumbar.#N#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 Laminectomy, facetectomy and foraminotomy (unilateral or bilateral with decompression of spinal cord, cauda equina and/or nerve root [s], [eg, spinal or lateral recess stenosis]), single vertebral segment; lumbar).#N#Discern whether the approach was posterior or anterior to choose the correct code. Table A illustrates commonly used, standalone decompression codes for spine surgery.#N#Table A: Standalone decompression codes for spine surgery
“It seems like coding spine cases is as complicated as doing the surgery,” said a spine surgeon at his first coding training session with me.#N#Spine procedure coding can make even the most confident coder squirm. But spine procedure coding doesn’t have to be difficult. In fact, it’s quite formulaic. Follow these five principles and spine procedure coding will go from scary to simple.
Warning: As with bone graft codes, instrumentation codes are add-on codes, and are never reported with modifier 62. Some payers (including Medicare) will incorrectly reimburse the instrumentation and some bone graft codes when billed with modifier 62; however, CPT® guidelines prohibit reporting the instrumentation and bone graft codes with modifier 62.
Common areas of confusion include CPT code 63042. Re-exploration at a level with a recurrent disc herniation can only use CPT code 63042. It should only be used after the global period for the first disc surgery has expired. Repeat facetectomy and lateral recess decompression at a level with a prior decompression must use CPT code 63047 if no disc work is per-formed. The presence of a lumbar disc herniation (722.1) drives the CPT code.Another common misconception is code 63047. This code can be used unilaterally or bilaterally as long as the decompression involves the lateral recess and foramen. Posterior fusion codes that involve disc preparation (22630,22633) already take into account the decompression work. Using ad-ditional decompression codes (63005, 63012, 63030,63042, 63047) is not al-lowed.
The use of posterior fusion codes that encompass disc work (eg, 22630 and 22633) already take into account the removal of lamina, facets and ligamen-tum flavum. The interbody fusion codes also were written assuming bilateral interbody placement which requires bilateral decompression. In cases that require decompression plus fusion (L4-5 spondylolisthesis with central and lateral recess stenosis), only the fusion codes can be used.
Incision made in front of the spine through a minilaparotomy or laparoscopy
Some procedures are integral to the fusion and cannot be coded separately. Take this example:
qtr 2014 specifies that a discectomy is almost always performed at the same time as spinal fusion surgery. An additional code should be assigned. Typically, a fusion involves partial removal of the disc and should be coded as excision of disc. If, however, the provider documents “total discectomy,” it should be coded as a disc resection.