ASC Coding Guidance: Laminotomy (Hemilaminectomy) Vs. Laminectomy — 63030 Vs. 63047
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Both CPT 63030 and CPT 63047 may be reported independently of each other when performed during the same operative session pending clinical documentation.
CPT 63030, Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disk; one interspace, lumbar (including open or endoscopically-assisted approach) normally bundles into 63047, Laminectomy, facetectomy and foraminotomy (unilateral or bilateral with decompression of spinal cord, cauda equina and/or nerve root(s) (e.g. spinal or recess stenosis), single vertebral segment, lumbar. When determining separate reporting, ask the following:
- Does the specific carrier or Medicare edits allows for a modifier to be appended?
- If the specific carrier or Medicare edits allows a modifier, is the service separate and distinct from the primary procedure in this instance with clinical/op documentation describing the additional procedure in detail?
- Is Medical necessity supported for the additional procedure to have been performed?
Let's say a laminectomy, decompression of the spine, facetectomy of the L2 vertebra for spinal stenosis and laminotomy with excision of the intervertebral disk at L1 for HNP is performed.
Since clinical documentation details both a laminectomy and a laminotomy being performed on different levels of the spine with medical necessity clearly defined, both CPT code 63030 (L1 HNP) and 63047 (L2 spinal stenosis) may be reported with the appropriate modifier.
Sequence CPT codes according to your commercial carrier and append the appropriate modifier to CPT 63030 to indicate a separate and distinct procedure/level.
Reimbursement note: While Medicare edits allows separate reporting of these procedures when clinically indicated, neither CPT 63030 nor CPT 63047 are found on Medicare's ASC approved list of surgical procedures. This does not preclude that all commercial carriers follow Medicare's footsteps. Verify reporting/reimbursement policies for all carriers prior to performing these procedures at your facility.
The information provided should be utilized for educational purposes only. Please consult with your billing and coding expert. Facilities are ultimately responsible for verifying the reporting policies of individual commercial and MAC/FI carriers prior to claim submissions.
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