Cpt codes lumbar discectomymicrodiscectomy procedure 63030 laminotomy, with decompression of nerve roots, including partial facetectomy, foraminotomy andor excision of herniated intervertebral disc. Currently, both 22630 and 22633 have edits with 63030 laminotomy hemilaminectomy, with decompression of nerve roots, including partial facetectomy, foraminotomy andor excision of herniated intervertebral disc. Mar 29, 2017 i have been getting denied codes 63047, 63048 when billed with 22633. Laminectomy, facetectomy and foraminotomy unilateral or bilateral. Cpt4 codes 63005, 63012, 63017, 63030, 63035, 63042, 63044, 63047 and 63048 when performed in conjunction with 22630,22632, 22633 andor 22634.
What is the difference between cpt 63030 and 63047. According to ama cpt guidelines when reporting 95970 95975 testing the integrity of the. Therefore, since ncci says fluoroscopy is included in all spinal procedures which would include 63047 unless cpt says you can bill it separately, cpt guidelines for 63047 do not say to code fluoro separately, and 63047 is not a valid primary cpt for 77002, you cannot report 77002 with 63047 when the fluoroscopy. Cpt code 63030 is defined as laminotomy hemilaminectomy, with. To further clarify, if a discectomy is performed during a laminectomy for stenosis, it is included in codes 6304563048. For example, 63030 lumbar laminotomy should generally not be billed with column 1 code 63047 lumbar laminectomy based on the cpt definition of these procedures since laminotomy is a subset or part of a laminectomy table1. Cpt code to classify or identify the procedure performed. Cpt code1 modifier if warranted procedure description 63020 50 laminotomy hemilaminectomy, with decompression of nerve roots, including partial facetectomy, foraminotomy andor excision of herniated intervertebral disc. Apr 02, 2016 invasive incisions for herniated disc 63030 and 63035not 63030 and 63030 stenosis. Cpt hcpcs codes preauthorization method responsible provider clinical criteria source 63051 lumbar, with or without fusion 22612, 22630, 63005, 63012, 63017, 63047 mhk rendering interqual thoracic, with or without fusion 22206, 22610, 63003, 63016, 63046, 63077 mhk rendering interqual.
This code can be used unilaterally or bilaterally as long as the decompression involves the lateral recess and foramen. Spine surgery guidelines musculoskeletal program clinical. Star medical center below pricing includes surgeon. Watch for the word interspace at the end of the descriptor for. I have been using the 59 modifier on 63047, 63048 if the operative note says decompression of neural elements was performed. Cpt code posterior cervical decompression education. Cpt coding for arthrodesis using the nuvasive maxcess system. Cpt 63047 involves not only removal of lamina for central decompression but also lateral recess decompression in the form of a facetectomy e.
Any of the listed cpt code procedures codes can be submitted on the claim for the authorized procedure. Cpt code 22633 with 63047, 63048 medical billing and. Cpt codes are referred to as category i codes and are fivedigit codes accompanied by narrative descriptions. By contrast, code 63047 is used to report procedures performed for lateral recess stenosis, for example, caused by either ligamentum flavum hypertrophy or facet arthropathy. The ama assigns a number of relative value units or rvus to most cpt codes to represent the physician work, malpractice costs, and practice expenses associated with a given procedure or service. The point is that the patient has had a prior discectomy at that same spinal level more than 90 days the postoperative global period of the lumbar discectomy code, 63030. These cpt codes are created and maintained by the american.
The difference between table of contents laminectomy. Sequence cpt codes according to your commercial carrier and append the appropriate modifier to cpt 63030 to indicate a separate and distinct procedurelevel. While medicare edits allows separate reporting of these procedures when clinically indicated, neither cpt 63030 nor cpt 63047 are found on medicares asc approved list. Both service were performed at l45 and well documented according to the cpt rules. All in cpt physician a code modifier mod 2 rvu 100% modifier applied cosurgery 22612 62 46. In addition, 63030 is a unilateral code, and should be reported for the first occurrence of disc herniation, cpt explains. Is 63030, laminotomy the most appropriate code to use for the new. Cpt codes nia provides authorization for primary surgery requested. Posterior fusion codes that involve disc preparation 22630,22633 already take into account the decompression work. Is it correct to code both a 63047 and a 63030 at the same level if a laminectomy with microdiscectomy was performed in the lumbar spine. Wiki cpt 63030 vs 63047 medical billing and coding. I dont feel this warrants billing 63047 59 or 6304859, which the physician did.
Based on the complete global service data for orthopaedic surgery manual, code 63030 is not. By contrast, code 63047 is used to report procedures performed for lateral recess stenosis, for example, caused by either ligamentum flavum hypertrophy or. Cpt assistant january 2001, page 12 states that these odes can be reported in addition to the fusion code if performed for decompression apply modifier 59 to the decompression code in c s instance. In the realm of cpt, 2 organ systems were being addressed. Question 63047 and 77002 medical billing and coding.
If you are only performing a microdiscectomy cpt 63030 or. Medicare payment, reimbursement, cpt code, icd, denial. Laminectomy, facetectomy and foraminotomy unilateral or bilateral with. General procedure name cpt codes msdrg codes bundled. Use cpt 63045 for cervical or cpt 63047 for lumbar, with additional. Gateway health medicare and gateway health medicaid. Deformity correction flat back syndrome, recurrent spinal stenosis, painful hardware. We received a denial for cpt code 63047 as inclusive and have tried to appeal, but medicare will not reverse the denial.
Cms denials for cpt code 22633 and 63047 karenzupko. Mar 15, 2002 interspaces, the two codes of an edit pair may be reported with modifier 59 appended to cpt code 63042 or 63047. Cpt code 63042,59 denied inclusive to 63047 forum codapedia. Cpt code primary surgery allowable billed groupings additional covered procedurescodes ancillary procedurescodes other procedure names authorization is provided for the primary surgery requested. Appears to be more work than cpt 63030 since doing more than just. Using additional decompression codes 63005, 63012, 63030,63042, 63047 is not allowed. Be sure to document the fact that the patient had prior surgery, and when, at that specific level. Cpt codes 63005 laminectomy with exploration andor decompression of spinal cord andor cauda equina, without facetectomy, foraminotomy or discectomy eg, spinal stenosis 1 or 2 vertebral segments. If 63042 was performed at l12 and 63047 was performed at l23 then you can bill both by appending the 59 modifier to 63042. Lumbar laminectomy, hemilaminectomy, laminotomy andor. Correct coding initiative policy manual for medicare. Cpt 63005 is generally used for removal of the lamina to provide central decompression of the spinal cord. Per cpt manual instructions and ncci edits, do not report anterior interbody.
However, laminectomy codes 63030, 63042, and 63047 are bundled. Codes 63030 and 63047 are bundled per the ncci edits with code 22630. Cpt 63042 laminotomy hemilaminectomy, with decompression of nerve roots, including partial facetectomy, foraminotomy andor excision of herniated intervertebral disc, reexploration, single interspace. Surgical treatment for spine pain page 1 of 31 unitedhealthcare commercial medical policy effective 01012021 proprietary information of unitedhealthcare. Cpt code 63030 is defined as laminotomy hemilaminectomy, with decompression of nerve roots, including partial facetectomy, foraminotomy andor excision of herniated intervertebral disc. Cpt 63047 laminectomy code is a unilateral or bilateral code and reports either without modifier why does this matter.
Laminotomy hemilaminectomy, with decompression of nerve roots. Based on the national correct coding initiative edits, code 63047 is. The item refers to reporting of lumbar decompression via laminectomy 63047, laminectomy, facetectomy and foraminotomy unilateral or bilateral with decompression of spinal cord, cauda equina. Magellan nia 2019 connecticare spine surgery procedures. Sep 25, 20 by cpt code 63042 is an inclusive component of the column one coded procedures 22630, 22633. Gateway health medicare and gateway health medicaid gateway. Spine management and prior authorization inpatient and. However, cpt has clarified that there are additional factors the coder must consider when selecting 63030 vs. There are multiple cpt codes that can be associated with each procedure. Aug 27, 2015 cpt 63005 is generally used for removal of the lamina to provide central decompression of the spinal cord. The cpt description of the laminectomy does not outline the excision of herniated disc only decompression of the neural. Cpt current procedural terminology is a registered trademark of the. We reported cpt code 63047 with 22633 for a laminectomy, facetectomy, foraminotomy at the same level to medicare. How to overcome the 5 biggest reimbursement challenges.
As to cpt 63030, claimant supplies ncci materials that support the primary code cpt 63047 highest value procedure in column 1 lists cpt 63030 in column 2 with an inidcator of 1 and thus, requiring a modifier. Cpt codes 63030 and 63047 are bundled per national correct coding initiative ncci edits with code 22630. Per the cpt guidelines listed under 63295 in the cpt manual you should be only using 63295 with 63172, 63173, 63185, 63190, 6320063290. Can we bill 63047 with modifier 50 when we do a bilateral procedure. Cpt code 20 medicare national average reimbursement for physician cms. This would be the same for cpt 63048 and the corresponding additioanl level of 63035. The most commonly used cpt codes are referred to as category i codes and are fivedigit codes accompanied by narrative descriptions. 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. The spine book mentions that decompression 63047 is unlikely reportable unless there has been more laminectomy and neural element decompression is. This preauthorization quick reference guide provides a. Cpt code 22633 with 63047, 63048 medical billing and coding.
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