Anterior Diskectomy L5-S1 with anterior Foraminotomy L4-S1

My Physician performed anterior diskectomy and anterior foraminotomy with interbody arthrodesis with implantation of PEEK Cage and allograft at L5-S1. I have coded 22558,22845 and 20931. Kinldy advise what CPT® needs to be coded for foraminotomy????

re: Anterior Diskectomy L5-S1 with anterior Foraminotomy L4-S1

Add the code 22851 for PEEK cage placement.

Documentation is missing for Laminotomy. If Laminotomy is done then we will add CPT® 63030 which includes foraminotomy.

re: Anterior Diskectomy L5-S1 with anterior Foraminotomy L4-S1

Thanks for the answer.

But physician didnt do laminotomy? Then how to go about this?

re: Anterior Diskectomy L5-S1 with anterior Foraminotomy L4-S1

See below is the comment from AMA. Please correlate with your operative notes.

Hope this will help!!!



Question

The descriptors of codes 22554 and 22630 describe anterior (22554) or posterior (22630) interbody technique arthrodeses to include laminectomy, and/or diskectomy to prepare the interspace (other than for decompression). In what procedural circumstance would the 63001-63048 code(s) be reported in addition to code 22630? Similarly, in what procedural circumstance would code(s) 63075-63078 be reported in addition to code 22554?

AMA Comment

For both codes 22554 and 22630, if the surgeon is removing disk and/or bony endplate solely with the need to prepare the vertebrae for fusion; then no additional 63000 series code(s) is reported. The appropriate 63045-63048, 63075-63078 code(s) should be reported, when in addition to removing the disk and preparing the vertebral endplate, the surgeon removes posterior osteophytes and decompresses the spinal cord or nerve root(s), which requires work in excess of that normally performed when doing a posterior lumbar interbody fusion (PLIF).

To report code 22554, Arthrodesis, anterior interbody technique, including minimal diskectomy to prepare interspace (other than for decompression); cervical below C2, in addition to code 63075-51, Diskectomy, anterior, with decompression of spinal cord and/or nerve root(s), including osteophytectomy; cervical, single interspace, the surgeon must have performed additional procedure(s) and work that leads to the decompression of neural elements. In most cases, the dura and/or neural elements are exposed to ensure decompression which, for reporting purposes, is considered over and above the work described by code 22554. Therefore, in this instance, the decompression procedure 63075 (with the modifier -51 appended) would be reported in addition to code 22554. Examples of types of additional procedures include drilling off the posterior osteophytes using the operating microscope, opening the posterior longitudinal ligament to look for free disk fragments (decompressing the spinal cord), or removing far lateral disk fragments to decompress the nerve roots. Note: The operating microscope code 69990 should not be reported since use of the operating microscope is included in code 63075.

To report code 22630, Arthrodesis, posterior interbody technique, including laminectomy and/or diskectomy to prepare interspace (other than for decompression), single interspace; lumbar, in addition to code 63047-51, 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, again additional procedure(s) must have been performed. For example, in spinal procedures performed on patients having lateral lumbar stenosis, the surgeon may need to perform additional work above and beyond that described by the PLIF, including facetectomy(ies) and/or foraminotomy(ies), to adequately decompress the nerve roots. For the purpose of this example, code 63047-51 should be reported in addition to code 22630.

Regarding the issue of laterality (unilateral versus bilateral procedures), codes 22554 and 63075 relate to operations that involve a midline anterior approach. For code 22554, the surgeon removes as much disk as is necessary to prepare the disk space, whereas code 22630 represents a technique that involves a bilateral posterior approach. Surgical practice has evolved over recent years to where the procedure is now performed from a unilateral approach. Delineation of "unilateral/bilateral" has never been part of the descriptor nomenclature of code 22630; nor has its valuation through the Relative Update Committee reflected laterality differentiation. Code 22630 should be reported without the use of the modifier -50, since presently there is no separation in the descriptor to differentiate whether the procedure was performed using a unilateral or bilateral approach.

To further clarify, code 22630 may also require the additional performance of a posterior fusion, which involves bone grafting and placement of posterior instrumentation. These procedures should be additionally reported. If the surgeon uses a threaded bone dowel or prosthetic device in the the disk space, then code 22851 should be reported. If any other type of bone graft is performed, the appropriate bone graft code should be reported.

The anterior fusion procedure described by code 22554 may also require bone grafting and placement of posterior instrumentation. Again, in this circumstance the appropriate bone grafting code and an appropriate anterior instrumentation code should be reported in addition to code 22554.

re: Anterior Diskectomy L5-S1 with anterior Foraminotomy L4-S1

A foraminotomy would not be performed from an anterior approach unless this was a tranS1 fusion, which is not an anterior procedure.