Coding
Laminectomy 101
Paul Saiz, MD
NASS Coding Committee 3 Crosses Orthopedic Spine Las Cruces, NM
Coding for posterior decompression is no longer straightforward. With the ever-increasing complexity of spine procedures and the expansion in new CPT codes, navigating the possible coding options has become more difficult. For this article, we will define laminectomy/laminotomy as posterior bone and ligament removal for the purpose of nerve and/ or spinal cord decompression. We will focus on the most common open decompression codes.
Prior to identifying the appropriate laminectomy code, five questions need to be asked:
1. Why is the decompression being performed? Is the purpose of the procedure because of nerve and/or spinal cord impingement from degenerative change (spinal stenosis), disc herniation, neoplasm, other?
2. Will the decompression involve the central canal, lateral recess, or intraforaminal/extraforaminal?
3. Is more than one procedure being performed at that interspace? eg, fusion, decompression, instrumentation
4. Will more than one interspace require decompression?
5. Is the surgery  regional? Regional codes can only be used once per operative setting regardless of the number of interspaces involved.
Definition of regional: Each of the codes are reported only once per region {eg, lumbar} for all of the decompression done in that region.
Decompression only: If the sole purpose of the procedure is to decompress, indications and identification of anatomic elements must be precise. Diagnosis drives the correct choice of laminectomy codes.
1. Degenerative change (Ligamentum flavum hypertrophy, disc bulge, facet hypertrophy eg, spinal stenosis)
A. Central decompression only (WITHOUT facetectomy, foraminotomy or discectomy)
B. Central decompression with lateral recess and neuroforaminal decompression (unilateral or bilateral)
2. Disc Herniation (main reason for surgery is nerve impingement secondary to HNP)
*Note: Discectomies are considered unilateral; if bilateral, may use modifier -50
3. Recurrent disc herniation surgery (NOT for repeat laminectomy)
4. Neoplasm (CODES ARE REGIONAL except for Intradural/Extramedullary neoplasms)
5. Excision by laminectomy for lesion other than Neoplasm (Epidural abscess or Synovial cyst, CODES ARE REGIONAL)
Decompression plus fusion at the same interspace:
Posterolateral arthrodesis only (no interbody fusion)
Use decompression code appropriate to pathology (e.g. Spinal stenosis 63047) along with the primary arthrodesis codes 22600, 22610, 22612, 22614
Interbody fusion +/- posterolateral arthrodesis (Lumbar only)
If pathology requires work in addition to that required for bilateral interbody placement (e.g. central stenosis) use these codes.
SPECIAL CODES
Laminectomy with removal of abnormal facets specifically for pars defect (Gill lami)
63012
(Cannot be used with interbody fusion 22630, 22632, 22633, 22634)
Decompression required lateral to pars/ facet or thru pars/facet
Transpedicular approach (decompression of cauda equina and/ or nerve roots)
Costovertebral approach (decompression of spinal cord or nerve roots)
Summary
By answering the five questions at the beginning of this article, a physician should be able to identify the appropriate code.
Author Disclosure
P Saiz: Other: TurningPoint Healthcare Solutions (D); Stock Ownership: Doctorpedia (<1%).