Basics of Procedures code CPT code 63020, 63030 & 63035
Being a medical coder, I think spinal surgery procedure are very interesting procedures to code. As we have learnt previously how we have coded the epidural spinal injection procedures in interventional radiology. The new codes for spinal injection are bundled codes and easy to use. The use of Fluoroscopic guidance code 77003 for spinal procedure should be used very carefully, because now it has been bundled in most of the CPT codes. Today, we will learn more about spinal surgery procedures. We will checkout today, some coding tips for laminotomy procedures represented by CPT code 63020, 63030 & 63035.
Laminotomy is actually performed to relieve the back pain caused by the ruptured or herniated intervetebral disc. Also, the pain may be because of spinal stenosis or disc displacement. Laminotomy is the partial removal (or by making a larger opening) of the lamina.
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Procedure performed for CPT code 63030, 63020 & 63035
A laminotomy is a minimally invasive or open incision procedure into the lamina of the vertebral arch to open the space and decompress the spinal cord or nerve roots. Sometimes it is also performed as hemilaminectomy, which removes only part of a vertebra, a lamina. Do not get confused laminotomy with laminectomy, since both are used as spinal decompression surgeries. Laminectomy is the complete removal of the lamina, while laminotomy is partial removal of lamina.
In this method, a midline incision is made through a posterior (back) approach overlying the vertebrae. The incision is carried down through the tissue to the paravertebral muscles, which are retracted. The ligamentum flavum, which attaches the lamina from one vertebra to the lamina of another, may be partially or completely removed. Part of the lamina is removed on one side to allow access to the spinal cord. If a disc has ruptured, fragments or the part of the disc compressing the nerves are removed. A partial removal of a facet (facetectomy) or removal of bone around the foramen (foraminotomy) may also be performed to relieve pressure on the nerve. When decompression is complete, a free-fat graft may be placed to protect the nerve root. If the ligamentum flavum was not removed, it is placed over the fat graft. Paravertebral muscles are repositioned and the tissue is closed in layers. Note that approaches represented by these codes may be open as described above or endoscopically assisted, which still requires open and direct visualization. In an endoscopically assisted approach, a small guide probe is inserted under fluoroscopic guidance. Using magnified video, as well as fluoroscopic guidance, the endoscope is manipulated through the foramen and into the spinal canal. Once the guide probe has been advanced to the surgical site, a slightly larger tube is manipulated over the guide probe. Surgical instruments are advanced through the hollow center of the tube. Herniated disc fragments are removed, and the disc is reconfigured to eliminate pressure on the nerve root(s). The endoscope is withdrawn. The incision is sutured or simply dressed with an adhesive bandage.
CPT code 63020 is reported if the disc is cervical;
CPT code 63030 reported if lumbar; and
CPT code 63035 is reported for additional interspaces, cervical or lumbar.
Both the procedures are performed primarily for herniated discs. Let us checkout few of them with full code description
63030– Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disc; 1 interspace, lumbar
63020 – Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disc; 1 interspace, cervical
63035 – Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disc; each additional interspace, cervical or lumbar (List separately in addition to code for primary procedure)
The above procedure codes can be differentiated with the spinal interface. For one cervical interspace, report CPT code 63020, for one lumbar interspace, report CPT code 63030 and for each additional interspace, either cervical or lumbar, report CPT code 63035.
During this procedure partial facetectomy (removal of part of lamina & facet joint) and foraminotomy can also be performed for additional pressure relief. Both facetectomy and foraminotomy are included in these procedures and should not be reported separately.
Do and Don’t with CPT code 63020, 63030 & 63035
Use modifier 50 for bilateral procedure, for CPT code 63035
Use CPT code 63035 only along with CPT code 63020 & 63030
Before using these procedure codes, do check the below supporting documentation in the medical report.
- Location: cervical, thoracic, lumbar or sacral.
- Approach: anterior, posterior or lateral extra cavity or percutaneous.
- Pathology: what was done and medical indication (decompression, discectomy, corpectomy and arthrodesis).