Laparoscopic Approach for Shunt

Question:

Can unlisted code 49320 or 49329 be coded along with 62223-62 for a General Surgeon who was a co-surgeon for ventriculo-peritoneal shunt creation if he used a laparoscopy?

Answer:

No, reporting either 49320 or 49329 for the laparoscopic approach is not appropriate.

According to the December 2012 issue of CPT Assistant, code 62230 with modifier 62 may be used by a general surgeon performing the procedure laparoscopically. The provided explanation states that the essential portion of the operation remains the same, and the incision size is not a factor.

Based on this guidance, the correct coding for this scenario is 62223-62 for both the general surgeon and the neurosurgeon.

*This response is based on the best information available as of 12/18/25.

Appropriate CPT Coding for OLLIF

Question:

I have a provider who wants to code 22558 for a procedure that is done posterior only. I am coding as TLIF, posterior interbody fusion with posterolateral fusion and Laminectomy, facetectomy, foraminotomy for decompression with discectomy. He states this is OLLIF not OLIF but still wants 22558. There is no repositioning of the patient. He does not enter the retroperitoneal space. All incisions are done posteriorly. Any guidance?

Answer:

Neither CPT 22558 nor CPT 22633 is appropriate for reporting an OLLIF procedure.

CPT 22558 describes an anterior interbody fusion and requires an anterior or anterolateral approach, typically involving retroperitoneal or transabdominal access. Since OLLIF is performed via a posterior-only, percutaneous approach, it does not meet the criteria for this code.

CPT 22633 describes a posterior interbody fusion combined with posterolateral fusion, typically used for TLIF procedures. However, OLLIF is a distinct technique that does not involve the same surgical exposure or instrumentation as TLIF.

According to CPT Assistant, June 2020, Volume 30, Issue 6, page 14: There is no specific CPT code that accurately describes the OLLIF procedure. Therefore, unlisted code 22899, Unlisted procedure, spine, should be reported. When reporting an unlisted code to describe a procedure or service, it is necessary to submit supporting documentation (e.g., procedure report) with the claim to provide an adequate description of the nature, extent, and need for the procedure, as well as the time, effort, and equipment necessary to provide the service.

Using 22899 ensures accurate representation of the surgical technique and compliance with AMA coding guidance, helping avoid potential denials or audits.

*This response is based on the best information available as of 12/04/25.

63267 or 22102?

Question:

A patient presents with lumbar discitis and osteomyelitis, and the provider performs a laminectomy with debridement of the disc and bone. Which CPT code is more appropriate in this scenario: 63267 or 22102?

Answer:

Thank you for asking!

In this case, the procedure involves a lumbar laminectomy with debridement of both disc and bone due to infectious pathology. CPT code 63267 is the correct choice, as it describes a lumbar laminectomy for excision or evacuation of an extradural intraspinal lesion other than a neoplasm. Code 22102 applies to the partial excision of the posterior vertebral component, which does not accurately reflect the work performed.

*This response is based on the best information available as of 11/20/25.

Still Unlisted?

Question:

I hope KZA can provide clarification. In the past, when coding EDAS for treatment of MoyaMoya disease, I used unlisted code 64999 compared to 61711. I have recently seen articles using 61711 only. Which would be the most appropriate code to use?

Answer:

Thank you for asking KZA!

Encephaloduroarteriosynangiosis (EDAS) is an indirect revascularization technique designed to improve blood flow to the brain without directly connecting blood vessels. Because CPT 61711 specifically describes a direct extracranial-to-intracranial arterial anastomosis, this does not accurately reflect EDAS technique.

You have been reporting this correctly. There is no CPT code for this, which is appropriately reported with unlisted CPT 64999.

If you’re seeing 61711 used in articles, it may be due to confusion with direct bypass procedures, such as STA-MCA bypass, which do fall under 61711. For EDAS, however, 64999 remains the most accurate and compliant choice.

*This response is based on the best information available as of 11/06/25.

63047 with 22633 for Interbody Fusion?

Question:

We would like some coding insight from KZA. Can you report CPT code 63047 with 22633 if you append modifier 51 to CPT code 63047 if the documentation supports the work done beyond that required for interbody fusion?

Answer:

Thank you for asking KZA!

CPT 63047 should not be reported with CPT 22633 at the same level/interspace.

Add-on codes (63052 & 63053) exist for decompression at the same level or interspace with a posterior lumbar interbody fusion (22630-22634). Remember, this is for decompression beyond preparation of the interspaces for fusion.

• 63052 – Laminectomy, facetectomy, or foraminotomy (unilateral or bilateral with decompression of spinal cord, cauda equina and/or nerve root[s] [eg, spinal or lateral recess stenosis]), during posterior interbody arthrodesis, lumbar; single vertebral segment

• 63053 – Laminectomy, facetectomy, or foraminotomy (unilateral or bilateral with decompression of spinal cord, cauda equina and/or nerve root[s] [eg, spinal or lateral recess stenosis]), during posterior interbody arthrodesis, lumbar; each additional vertebral segment

In the submitted scenario, the appropriate code to report is CPT 63052 if your documentation supports additional decompression.

*This response is based on the best information available as of 10/23/25.

Halo Adjustment?

Question:

What CPT code should be used to adjust a Halo device without anesthesia on postoperative Days 1, 2, and 5? CPT code 20664 was used to bill for the initial application of the Halo device. These adjustments are being performed in preparation for an upcoming surgery.

Answer:

Thank you for reaching out to KZA!

CPT codes 20664 and 20661 both include the application and removal of the Halo device. Any adjustments made during the 90-day global period following the initial procedure are considered part of the global surgical package and are not separately reportable.

*This response is based on the best information available as of 10/09/25.