Surgery Center Coding Guidance: Posterior Laminectomy or Laminotomy
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The following article is written by Stephanie Ellis, RN, CPC, president of Ellis Medical Consulting.
Laminectomy with exploration and/or decompression of spinal cord and/or cauda equine, without facetectomy, foraminotomy or diskectomy, (eg, spinal stenosis), one or two vertebral segments: The spinous process is removed and bony overgrowths or tissue is removed until the dural sac and nerve roots are free from compression. Use code 63001 for cervical, use 63003 for thoracic and lumbar (except for the spondylolisthesis condition, which would be coded 63012 [referred to as the Gill procedure]) and use 63011 for sacral. If more than two vertebral segments are performed, use code 63015 for cervical, for thoracic use code 63016 and for lumbar use code 63017.
Laminotomy (cervical code 63020 or lumbar code 63030, with the add-on code for each additional level as +63035; unilateral): This is the most common spine procedure performed. In these procedures, part of the lamina is removed on one side to allow access to the spinal cord. Use the -RT and -LT or -50 modifiers with these codes. If a disk has ruptured, fragments or the part of the disk compressing the nerves are removed. A partial removal of a facet or removal of bone around the foramen may also be performed to relieve pressure on the nerve. The lumbar approach may be performed as either an open or endoscopic procedure.
Endoscopic procedure: In an endoscopic approach, a small guide probe is inserted under fluoroscopic guidance. Using magnified video, as well as fluoroscopic guidance, the endoscope is manipulated through the foramen and into the spinal canal. When the guide probe is in the surgical site, a larger tube is manipulated over the guide probe. Instruments are advanced through the hollow center of the tube. Herniated disk fragments are removed and the disk is reconfigured to eliminate pressure on the nerve roots. The same codes discussed above (63020 and 63030) are used for the endoscopic technique.
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