To do spinal coding right in 2019, you’ve got to get straight on several new techniques, guidelines and procedures that promise to complicate your billing.
And you’ve got to do it quick given that payers and regulators are scrutinizing spinal procedures more closely than ever before, notes professional coder Margie Scalley Vaught. In her ProfEdOnDemand webinar,
“2019 Spinal Procedures: Documentation, Coding & Understanding,” she covers a wide variety of topics related to spinal procedures coding, including one that many coders find particularly confusing: laminectomies versus laminotomies and their accompanying codes.
3 Codes, 2 Procedures
You aren’t alone if you’re stymied over the proper use of codes 63030, 63042, and 63047. All three spinal CPT® codes deal with somewhat similar procedures—and recent NCCI bundling edits change how you can use these codes in your practice.
Before getting into bundling details, here’s a quick review of the two spinal procedures covered by these three codes:
- Laminotomy (63030 and 63042): The physician relieves pressure in the vertebral canal by removing part of the lamina of a vertebral arch.
- Laminectomy (63047): The complete removal of the lamina.
Suffix is key: To help you remember the distinction between the two procedures, think about a phlebotomy (i.e., removal of only some of your blood) versus a hysterectomy (i.e., complete removal of the uterus). The suffix “-otomy” means “cutting into a part of the body,” whereas “-ectomy” means complete removal.
Differentiate 2 Kinds of Laminotomies
Now to distinguish between codes 63030 and 63042.
Their definitions both begin the same way: laminotomy (hemilaminectomy) with decompression of nerve root(s), including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disc.
The differences are found at the very end of each definition:
- 63030: … one interspace, lumbar (including open or endoscopically-assisted approach)
- 63042: … reexploration, single interspace
So 63042 is used for revision discectomies. And 63030, in addition to describing laminotomies performed with a discectomy to treat spinal disc herniation using an open procedure, can also describe those performed under endoscopic assistance.
63047: CMS Changes Bundling Rules
Believe it or not, the two codes discussed above are much more straightforward than the “problem child” of the group: code 63047.
Its definition states: 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).
This language has tripped up new and experienced coders alike because of its confusing documentation requirements. And recent bundling edits may leave you more, not less, confused.
For 2017, 63047 and its sister code 63048 are bundled into arthrodesis codes 22630 and 22633. This means two things for your coding practice:
- Decompression will no longer be billable if performed at the same level(s) as arthrodesis, and
- It’s more important than ever to understand the ins and outs of spinal fusion After all, how do you know if decompression was performed at the same level as arthrodesis unless you know what the levels are?
Remember: Order Is King
It’s not hard to see how quickly spinal CPT® codes can become extra confusing. To up your coding game, you’ll need to nail down all the available procedures, fusion levels, and approaches: anterior, posterior, or lateral, says Margie Scalley Vaught.
In her webinar “2019 Spinal Procedures: Documentation, Coding & Understanding,” Vaught explains all the 2019 NCCI guideline changes that are taking place for spinal coding—including the new directive information on add-on codes, primary codes, and bundling issues.
