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)

(1-2 segments)
Cervical
63001
Thoracic
63003
Lumbar
63005
Sacral
63011
(3+ segments)
Cervical
63015
Thoracic
63016
Lumbar
63017

B. Central decompression with lateral recess and neuroforaminal decompression (unilateral or bilateral)

Cervical
63045
Thoracic
63046
Lumbar
63047
Additional Level
63048 (code can only be used with 63045, 63046, 63047)

2. Disc Herniation (main reason for surgery is nerve impingement secondary to HNP)

Cervical
63020
Lumbar
63030
Additional Interspace
63035

*Note: Discectomies are considered unilateral; if bilateral, may use modifier -50

3. Recurrent disc herniation surgery (NOT for repeat laminectomy)

Cervical
63040
Additional Cervical Interspace
63043
Lumbar
63042
Additional Lumbar Interspace
63044

4. Neoplasm (CODES ARE REGIONAL except for Intradural/Extramedullary neoplasms)

Intraspinal/Extradural
Intradural/Extramedullary
Intradural/Intramedullary
Cervical
63275
Cervical
63280
Cervical
63285
Thoracic
63276
Thoracic
63281
Thoracic
63286
Lumbar
63277
Lumbar
63282
Thoracolumbar
63287
Sacral
63278
Sacral
63283
Additional level
63290

5. Excision by laminectomy for lesion other than Neoplasm (Epidural abscess or Synovial cyst, CODES ARE REGIONAL)

Intraspinal/Extradural
Intraspinal/Intradural
Cervical
63265
Cervical
63270
Thoracic
63266
Thoracic
63271
Lumbar
63267
Lumbar
63272
Sacral
63268
Sacral
63273

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.

Lumbar
63052
Additional level
63053

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)

Thoracic
63055
Lumbar (transfacet or extraforaminal, cannot be used with IB fusion)
63056
Additional segment (thoracic or lumbar)
63057

Costovertebral approach (decompression of spinal cord or nerve roots)

Thoracic
63064
Additional segment
63066

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%).

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