Forum - Questions & Answers

Jul 21st, 2011 - padi1coder 10 

Lumbar laminectomy including synovial cystectomy

My provider did a lumbar laminectomy, decompression, medial facetectomy, foraminotomy on L2-3-4-5 bilaterally, synovial cystectomy on the left at L2-L3. He coded this: 63047, 63048 (x 4). I think that only (3) 63048 should be coded instead of coding an additional 63048 for the cystectomy since the description states bilateral, right? I would appreciate any help. Thanks in advance....

Jul 21st, 2011 - jschmutz   323 

re: Lumbar laminectomy including synovial cystectomy

These codes are billed per segment. If he did a laminectomy at L2, L3, L4 and L5 then this would be a 4 level laminectomy: 63047 and 63048 x3 (the cyst excision would be included in the laminectomy code)

Feb 13th, 2014 - Brooksstarnes 1 

re: Lumbar laminectomy including synovial cystectomy

Is there any reason you could not code the 63267 instead of the other codes. The work volume is greater in the case I'm looking at and I feel would justify using that code instead of 63047.

Oct 29th, 2015 - LBAROGIANIS 250 

re: Lumbar laminectomy including synovial cystectomy

Per Humana is denying ICD9 727.40 with CPT® 63267. The AANS books states this is correct. Humana states this: Services performed should address the patients symptoms reported by the diagnosis codes. One or more of the diagnosis codes submitted are considered clinically unexpected or unlikely to support the procedure or services performed.
The pathology report confirms this is a synovial cyst. I just don't understand this denial at all. Can anyone shed any light on this? I have been fighting this denial since 04/2015.

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