laminoforaminotomy

For a procedure listed as a Rt L5-S1 laminoforaminotomy (Operative report stating Rt L5 laminotomy and Rt S1 Laminotomy) would the coding be 63030 (one interspace) or would this be coded as 63030, 63035?

definitions

The Laminotomy is the interspace (63030 & 63042). The laminectomy is the segments (63047).

Laminoforaminotomy

Use the 63030 and 63042 codes when the laminoforaminotomy is done in conjuction with a diskectomy - so the primary diagnosis is disk disease. Use 63047 for a laminoforaminotomy when no diskectomy is performed - remember, the code says "unilateral or bilateral" so you can still use 63047 if only one side is done.

Kim Pollock, RN, MBA, CPC
KarenZupko & Associates, Inc.
www.karenzupko.com

laminoforaminotomy

Thanks Kim I do understand the differenct between the 63030 and 63047 but what I am confused about is the "interspace" in the description. If the doctor does a laminotomy on the RT L5 and the RT S1 is it coded with just the 63030 or is it coded with the 63030 and 63042. Is working on both considered under the "one interspace" or do you code both levels? Thanks

Laminoforaminotomy

"Interspace" in the decriptor for 63030 and 63042 means there is work between the two vertebral bodies - that translates to removing the disk. You don't mention discectomy at all which means you would NOT use 63030 or 63042. You'd use 63047 instead. It is not appropriate to use two stand-alone code, like 63030 and 63042, for a procedure at one level. Choose one code to describe the work performed. So if a laminoforaminotomy and discectomy were done at right L5-S1 then use 63030 (if virgin surgery) or 63042 (if re-exploration). If only a laminoforaminotomy and no discectomy was done at the right L5-S1 to decompress the L5 nerve root (eg, inferior laminectomy at L5 and superior laminectomy at S1) then use 63047. But the point is only one primary procedure code per spinal level.

Kim Pollock, RN, MBA, CPC
KarenZupko & Associates, Inc.
www.karenzupko.com

laminoforaminotomy

Sorry I meant 63030 and 63035 and it was a laminoforaminotomy and microdiskectomy. So 63030 would be my code. That is what I have been using but I just got confused because I recently saw a picture it showed a portion of the RT L5 and a portion of the RT S1 removed and I started wondering if both should be coded separetely by using the 63030 for the L5 and the 63035 for the S1. Thanks for all your help.

Laminoforaminotomy and microdiskectomy

Choose the code based on number of disk spaces addressed regardless of the number of lamina "touched". So a right L5-S1 laminoformanotomy and microdiskectomy is one code, 63030, because only one disk was removed...the disk at L5-S1.

Kim Pollock, RN, MBA, CPC
KarenZupko & Associates, Inc.
www.karenzupko.com

re: Laminoforaminotomy

How would you code a procedure with a diagnosis of lumbar spinal stenosis and lumbar herniation at L2-L3? The documentation shows removal of disk fragments was performed. I say 63030, but the surgeon says 63047. I feel since disk fragments were removed, and the diagnosis show a herniation, 63030 is the code because the descriptor of 63047 doesn't mention disk removal. Please advise! TIA!

Rich