CPT® Assistant January 2012 page 14
Frequently Asked Questions:Category III Codes
Question: What is the appropriate CPT® code to report a minimally invasive lumbar decompression (MILD) procedure: code 22899 or code 64999?
Answer: Effective July 1, 2011, two codes are reportable for the MILD procedure depending on the anatomical area involved. Code 0274T, Percutaneous laminotomy/ laminectomy (interlaminar approach) for decompression of neural elements, (with or without ligamentous resection, discectomy, facetectomy and/or foraminotomy), any method, under indirect image guidance (eg, fluoroscopic, CT), with or without the use of an endoscope, single or multiple levels, unilateral or bilateral; cervical or thoracic, and code 0275T, Percutaneous laminotomy/laminectomy (interlaminar approach) for decompression of neural elements, (with or without ligamentous resection, discectomy, facetectomy and/ or foraminotomy), any method, under indirect image guidance (eg, fluoroscopic, CT), with or without the use of an endoscope, single or multiple levels, unilateral or bilateral; lumbar. It is not appropriate to report either of the unlisted codes (22899 or 64999) after the implementation date of July 1, 2011. For more information see the AMA Category III code web site at http://www.ama-assn.org/resources/do...tcat3codes.pdf, lists.
New minimally invasive therapeutic spine techniques and technology have led to questions as to when it is appropriate to report an existing spine surgery code(s) when the procedure involves an open surgical technique, and/or a combination of open and endoscopic techniques. The following information may help to clarify the most correct code selection.
Question: May either CPT® code 63030 or 63047 be reported for a Minimally Invasive Lumbar Decompression (MILD) described as follows: Through a small incision and using fluoroscopic guidance, the surgeon performs an epidurogram to identify the specific lumbar stenosis location, followed by a small laminotomy and decompression resection of the ligamentum flavum to treat the patient's central canal spinal stenosis.
Answer: No, procedures using Minimally Invasive Lumbar Decompression (MILD) devices should be reported using unlisted spine code, 22899 or 64999, Unlisted procedure, nervous system. The MILD procedure involves a fluoroscopic, needle-based procedure without direct visualization of critical neural structures. The technique includes fluoroscopically guided placement of a guide wire obliquely introduced into the facet joint. An epidurogram is performed and the contrast material identifies the dura. Dilators are placed, ending with a slender Kerrison-type rongeurs, and the facet/ligament is resected. Also the devices used for the "MILD" procedure are not intended for disc procedures, but for tissue resection at the perilaminar space within the interlaminar space, and at the ventral aspect of the lamina. These devices are not intended for use near the lateral neural elements and remain dorsal to the dura using image guidance and anatomical landmarks.
It would not be appropriate to report code 63030, Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disc, including open and endoscopically assisted approaches; 1 interspace, lumbar, as the MILD procedure is a needle-based approach and is not intended for removal of disc material vs an open surgical or open with endoscopic-assisted approach (code 63030).
To further clarify usage, code 63030 may be reported only when an open surgical technique (not an endoscopic approach/technique) is used and the intrinsic essential components of this code are performed; namely, a resection of the vertebral component, spinous processes, and lamina, which must include a discectomy, for decompression of the nerve root(s), as well as any laminotomy or laminectomy foraminotomy along with partial facetectomy, as needed for decompression of the nerves or required as part of the surgical approach. The repair of small intraoperative dural laceration or leak, and harvesting and placement of soft tissue graft, muscle, or fat when obtained from within the primary surgical incision, are considered part of the intraservice work and are not reported separately. If laminotomy with decompression of nerve root(s) is not performed, then it would not be appropriate to report code 63030 for the excision of the herniated intervertebral disc. However, code 63030 may be reported for an open procedure involving the use of a tubular retractor and endoscopic illumination and visualization rather than microscopic illumination and visualization.
It would also not be appropriate to report code 63047, Laminotomy, facetectomy and foramenotomy (unilateral or bilateral with decompression of spinal cord, cauda equina and/ or nerve root, [eg, spinal or lateral recess stenosis]), single vertebral segment: lumbar, for a "MILD" procedure as code 63047 is only reported if an open surgical technique (not solely an endoscopic approach/technique) is used and when the intrinsic components of this code essential elements are performed, namely a resection of the vertebral component, spinous processes which includes a laminotomy, laminectomy or hemilaminectomy (unilateral or bilateral) lamina, along with foraminotomy with partial facetectomy.
The repair of small intraoperative dural laceration or leak, and harvesting and placement of soft tissue graft, muscle, or fat when obtained from within the primary surgical incision are considered part of the intraservice work of this code and are not reported separately. If laminotomy, laminectomy, or hemilaminectomy with decompression of nerve root(s) is not performed, it would not be appropriate to report code 63047 for the procedure. Since this code requires direct or magnified visualization of the surgical site, a fluoroscopically based procedure such as MILD should not be reported with this code.